For prescription drug dependence treatment, buprenorphine maintenance trumps detoxification

For treating patients with prescription opioid dependence in primary care,buprenorphine maintenance therapy is superior to detoxification, according to a new study by Yale School of Medicine researchers published in the Oct. 20 issue of JAMA Internal Medicine.

Prescription opioid dependence has been increasing for the last 15 years and now surpasses heroin dependence. Doctors are also writing more prescriptions for pain management, which has led to higher.

“Primary care physicians lack evidence-based guidelines to decide between detoxification or providing patients with ongoing maintenance therapy,” said Fiellin.

Fiellin and his colleagues conducted a 14-week randomized clinical study of 113 patients with prescription opioid dependence. Patients randomly received either buprenorphine detoxification or ongoing buprenorphine maintenance therapy. Buprenorphine is a medication used to treat addiction. Study participants in the detoxification group received six weeks of stable doses of buprenorphine followed by three weeks of tapering doses. All patients received physician and nurse support and drug counseling for all 14 weeks.

The team found that patients in the detoxification group tested positive for illicit opioid use more often than those in the maintenance group. Patients who received ongoing buprenorphine were less likely to use illicit opiates. Few of the patients in the detoxification group stayed in treatment or were able to abstain after the medication was discontinued.

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