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Improving temporal efficiency of outpatient buprenorphine induction
Erik W Gunderson1, Frances R Levin, Margaret M Rombone
1Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA. erikgunderson@virginia.edu
The American Journal on Addictions
|August 16, 2011
Summary
Physician adoption of office-based opioid treatment is hindered by buprenorphine induction. This study found that with experience, induction time decreased significantly, with patients arriving later in withdrawal and receiving medication faster.
Area of Science:
- Addiction Medicine
- Pharmacology
- Clinical Practice
Background:
- Buprenorphine induction is a significant barrier to physician adoption of office-based opioid dependence treatment.
- Streamlining the induction process is crucial for expanding access to medication-assisted treatment.
Purpose of the Study:
- To examine the buprenoprhine induction process in an outpatient setting.
- To identify strategies that improve induction efficiency.
- To inform clinical guidelines for buprenorphine induction.
Main Methods:
- Retrospective chart review of 41 patients undergoing buprenorphine induction.
- Patients divided into three chronological groups (Phases 1-3) to assess changes with experience.
- Analysis of timed withdrawal scales, medication logs, and clinical notes.
Main Results:
- Induction time decreased from a mean of 5.5 hours in Phase 1 to 1.5 hours in Phase 3 (p < .001).
- Later phase patients experienced longer opioid abstinence, higher withdrawal scores, and less delay to medication initiation (5 min in Phase 3 vs. 133 min in Phase 1).
- Later phase patients showed more rapid titration, faster withdrawal relief, and increased use of preinduction ancillary medications.
Conclusions:
- Physician experience improves buprenorphine induction efficiency.
- Patients arriving with greater withdrawal and longer abstinence may facilitate a quicker induction.
- Procedural modifications can mitigate the induction barrier, encouraging wider adoption of office-based opioid treatment.
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