July 27, 2006

Heroin Dependence Can Be Treated in Docs’ Offices

NEW YORK -- 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.