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Unobserved "home" induction onto buprenorphine
Joshua D Lee1, Frank Vocci, David A Fiellin
1From the Department of Population Health (JDL), Division of General Internal Medicine, New York University School of Medicine, New York; Friends Research Institute (FV), Baltimore, MD; and Department of Internal Medicine (DAF), Yale University School of Medicine, New Haven, CT.
Journal of Addiction Medicine
|September 26, 2014
Summary
Unobserved buprenorphine induction at home is feasible and appears safe, though evidence on its effectiveness compared to observed induction is limited. This practice is widespread, offering convenience but requiring careful consideration of benefits and risks.
Area of Science:
- Addiction Medicine
- Pharmacology
- Public Health
Background:
- Unobserved buprenorphine induction, where patients self-administer medication outside clinical settings, is increasingly common.
- This practice contrasts with traditional observed induction during office visits.
- A comprehensive review of existing literature is needed to assess its feasibility, safety, effectiveness, and prevalence.
Purpose of the Study:
- To review and synthesize the available literature on unobserved buprenorphine induction.
- To evaluate the feasibility, acceptability, safety, and effectiveness of unobserved induction.
- To determine the prevalence of unobserved induction in clinical practice.
Main Methods:
- Systematic search of English language literature for studies on unobserved buprenorphine induction and outcomes.
- Assessment of clinical studies based on design strength, bias, and validity.
- Review of provider surveys for prevalence data and examination of international treatment guidelines.
Main Results:
- Ten clinical studies indicated feasibility, especially in primary care, with weak to moderate evidence for comparable safety to observed induction.
- Evidence on effectiveness (retention, adherence, abstinence) remains insufficient or weak.
- Provider surveys reveal observed induction logistics as barriers, with unobserved induction being widespread in some regions; international guidelines predominantly favor observed induction.
Conclusions:
- Insufficient evidence exists to definitively state if unobserved buprenorphine induction is more, less, or equally effective as observed induction.
- Observational studies suggest feasibility and low adverse event rates, with widespread adoption noted in US and French surveys.
- Clinicians and policymakers should weigh the benefits of observed induction (supervision) against the convenience and comparable safety of unobserved induction.