Patterns of opioid use during initial buprenorphine/naloxone treatment in relation to changes in opioid management...

There is limited information on the most commonly used opioid reported at the time of presentation for treatment with buprenorphine/naloxone and the extent to which state policy may impact type of opioid use reported.

Retrospective study, total N = of 595 from four different medical locations from January 1, 2009 to July 1, 2016 that provided buprenorphine/naloxone treatment in Louisville, Kentucky. Study aims included identifying the most commonly used opioid at the time of treatment before and after the creation of a state-wide opioid prescribing surveillance system (ie, the 2012 House Bill 1 [HB1]), and determine the extent to which clinical setting, sex, age, and insurance type impacted type of opioid reported during the intake appointment.

Non-heroin opioid use decreased in the academic and private practice settings following passage of HB1, while heroin use increased in all three settings. After controlling for clinical setting and demographic characteristics, there was a significant increase in patients who reported using heroin (vs. non-heroin opioid) (RR = 25.00, p ≤ .001, CI = 12.08-51.73) and a significant increase in patients who reported using opioid agonists (vs. non-heroin opioid) (RR = 6.56, p ≤ .001, CI = 4.10-10.50) following enactment of HB1.

After the passage of HB1, there was a significant increase in patients reporting heroin use and opioid agonists compared to non-heroin opioids when presenting for treatment.

There has been a notable shift in the opioid epidemic, which is evident in the outpatient treatment settings. (Am J Addict 2018;27:560-566).