Buprenorphine for opiate dependence: clinic based therapy in Israel

Opioid dependency is characterized by repeated use of an opioid drug despite physical dependence, behavioral impairments and social dysfunction. Therapeutic approaches for the treatment of opioid dependence are total abstinence and opioid agonist maintenance treatment (OAMT). Opiate agonist maintenance therapy is administered using opioid replacement pharmacological agents, i.e., methadone or buprenorphine. Methadone acts as a full opiate agonist while buprenorphine acts as a partial agonist. Strict supervision is necessary when dispensing methadone, because overdose can be fatal. Buprenorphine associates with opioid receptors slowly but with high affinity, and dissociation from the receptor site is (pseudo) irreversible. It is safer than opioid full agonists such as methadone.

We probed the therapeutic efficacy of buprenorphine using a retrospective evaluation of numerical data in the first private buprenorphine clinic in Israel. Data was collected for all patients attending the clinic in December 2012. Our indicator for treatment success is retention in the program.

During the years 2005-2012, 1,399 individuals approached the clinic; 1,224 (87.5%) of them attended the clinic at least twice; treatment adherence in this group was 66.5 % at the end of one year.

The success rates of patients who are treated with buprenorphine and are able to eventually return to their families and re-enter the workforce is encouraging. Thus, the community based minimal intervention treatment model using buprenorphine for the treatment of opiate dependence is a viable treatment option in the war against opiate abuse.