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ABSTRACT
Background: Interim methadone treatment (i.e., temporary medication-only treatment) has been tested in a few U.S. studies as a method for facilitated referral to and initiation of opioid maintenance treatment in heroin dependence. However, despite the favorable safety profile of buprenorphine compared with methadone, interim treatment with buprenorphine rarely has been tested and reported in the scientific literature. The present pilot effectiveness study aims to assess the feasibility of an interim buprenorphine treatment for initiation of individuals with opiate dependence into full-scale opioid maintenance treatment, and to study baseline predictors of successful transfer to full-scale treatment. Methods: Interim treatment was introduced in a high-threshold setting with waiting lists to opioid maintenance treatment. Consecutive patients on the waiting list were offered the option to enter interim treatment. The interim program was a medication-only condition with supervised daily doses of buprenorphine-naloxone. The main outcome was successful transfer to full-scale opioid maintenance treatment, which required a drug-free urine sample. Results: Forty-four patients entered interim buprenorphine treatment. Among them, 57% (n = 25) were successfully transferred to full-scale treatment after an average of 44 days. Remaining patients could not be transferred, generally because they did not manage to become drug-free. Successful transfer to full-scale treatment was associated with a lower baseline Alcohol Use Disorders Identification Test (AUDIT) score (4.4 vs. 12.6; P < .001) and tended to be associated with lower cannabis use (5.2 vs. 10.4 days during the past 30 days; P = .06) and lower heroin use (7.2 vs. 9.9 days; P = .09) prior to baseline. In a logistic regression analysis, only lower AUDIT score predicted successful treatment entry. Conclusions: According to these pilot data, supervised buprenorphine-naloxone in a medication-only interim treatment condition appears to be a feasible way to improve treatment initiation in a high-threshold setting. Polydrug use, including higher levels of alcohol consumption, may predict a more complicated course in interim treatment.
Acknowledgments
We are grateful to the staff of the methadone clinic, Department of Psychiatry Lund, for their great work and importance in the present study. We would also like to thank Agneta Öjeghagen at the Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, for valuable help and advice. Also, we are grateful for the collaboration from social services of the municipalities in the catchment area of Lund, for their work with baseline interviews in the study.
Author contributions
Abrahamsson, Lilliebladh, Widinghoff, and Hakansson took part in the writing of the manuscript. Abrahamsson was responsible for the finalization of the manuscript. Analyses were carried out by Lilliebladh, Widinghoff, and Hakansson. Hakansson and Gedeon developed the project and had the main scientific and clinical responsibility. Nilvall, Widinghoff, and Lilliebladh carried out the data collection. Nilvall and Gedeon were responsible for clinical work in the project.
Funding
The present study was financed by the Department of Psychiatry Lund, Psychiatry Skane, Sweden, where the study took place. The funding agency was not involved in the design or execution of the study, or in the preparation of the manuscript. The authors declare that they have no conflicts of interest.