People dependent on heroin, cocaine or prescription opioids may not need to
go to specialized drug addiction centers to get treatment. Help can be as close
as their regular doctor's office, clinicians at Yale University School of
Medicine report in this week's New England Journal of Medicine.
Dr. David A. Fiellin and his colleagues in New Haven, Connecticut, conducted
a 24-week clinical trial that included 166 opioid-dependent patients who were
treated in a primary care setting using brief counseling and a medication
regimen.
Treatment involved taking Suboxone tablets, which contain a combination of
buprenorphine and naloxone known to combat drug cravings, along with weekly
counseling by a primary care nurse.
In the counseling sessions, discussion included efforts to achieve or
maintain opiate abstinence, the use of self-help groups, and results of weekly
analysis of urine specimens. Standard sessions lasted 20 minutes, while enhanced
counseling sessions were 45 minutes with more in-depth drug counseling.
Patients were randomly assigned to once-weekly standard counseling and
medication distribution, thrice-weekly standard counseling and medication, or
enhanced counseling with medication dispensed three times per week. Medication
was to be self-administered at home.
Patients in all of the treatment groups achieved significant reductions in
opioid use compared with the start of the study, although there were differences
according to treatment group.
Overall, average self-reported frequency of opioid use fell from 5.3 days per
week before treatment to 0.4 days per week during treatment.
Patients preferred standard counseling and once-weekly medication
distribution over the other two strategies, the investigators found, but the
proportions of patients completing the study did not differ significantly among
groups.
The researchers saw no significant differences among groups in adherence to
treatment, frequency of opioid-negative urine specimens, or in the maximum
number of consecutive weeks of abstinence.
The team concludes that primary care, office-based treatment of opioid
dependence is feasible and that nurses can deliver it.
"The recent finding that the availability of buprenorphine-naloxone attracts
new patients to treatment for addiction provides support for federal efforts to
expand access to the treatment," Fiellin's group writes. However, they add,
measures are needed to improve adherence and thereby improve treatment outcomes.
SOURCE: New England Journal of Medicine, July 27, 2006.
