Family Medicine Update

Buprenorphine treatment in an urban community health center: what to expect.

Fam Med. 2008 Jul-Aug;40(7):500-6

Authors: Cunningham C, Giovanniello A, Sacajiu G, Whitley S, Mund P, Beil R, Sohler N

BACKGROUND: Despite new opportunities to expand buprenorphine treatment for opioid dependence, use of this treatment modality has been limited. Physicians may question their ability to successfully treat opioid-dependent patients with buprenorphine in a primary care setting. We describe a buprenorphine treatment program and treatment outcomes in an urban community health center. METHODS: We conducted retrospective chart reviews on the first 41 opioid-dependent patients treated with buprenorphine/naloxone. The primary outcome was 90-day retention in treatment. RESULTS: Patients’ mean age was 46 years, 70.7% were male, 58.8% Hispanic, 31.7% black, 57.5% unemployed, and 70.0% used heroin prior to treatment. Twenty-nine (70.7%) patients were retained in treatment at day 90. Compared to those not retained, patients retained in treatment were more likely to have used street methadone (0% versus 37.9%) and less likely to have used opioid analgesics (54.6% versus 20.7%) and alcohol (50.0% versus 13.8%) prior to treatment. Of the 25 patients with urine toxicology tests, 24% tested positive for opioids. CONCLUSIONS: Buprenorphine treatment for opioid dependence in an urban community health center resulted in a 90-day retention rate of 70.7%. Type of substance use prior to treatment appeared to be associated with retention. These findings can help guide program development.

PMID: 18928077 [PubMed - in process]

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Veterans affairs primary care clinicians’ attitudes toward chronic pain and correlates of opioid prescribing rates.

Pain Med. 2008 Jul-Aug;9(5):564-71

Authors: Dobscha SK, Corson K, Flores JA, Tansill EC, Gerrity MS

OBJECTIVES: The primary objective of this study was to identify veterans affairs (VA) primary care clinicians’ attitudes regarding chronic pain treatment. A secondary objective was to explore relationships between clinician and practice characteristics and an objective measure of opioid prescribing rates. DESIGN: Cross-sectional study of clinician survey and pharmacy data. PARTICIPANTS: Forty-five VA clinicians from five primary care clinics of one VA medical center. MEASURES: Survey of pain-related attitudes and behaviors, satisfaction with treatment resources, and job satisfaction; percentage of patients in clinicians’ panels prescribed opioids (PCPO). RESULTS: Seventy-one percent of clinicians felt moderately or strongly confident in their ability to treat chronic pain, and 77% moderately or strongly agreed that skilled pain management is a high priority. However, 73% moderately or strongly agreed that patients with chronic pain are a major source of frustration and 38% reported moderate or greater dissatisfaction with their ability to provide optimal pain treatment. Fifty-two percent moderately or strongly agreed that their management is influenced by previous experiences with patients addicted to drugs. The mean PCPO was 16.5% (SD = 6.7). In bivariate comparisons, clinician panel size, job and resource satisfaction, and professional training were associated with opioid prescribing rates. CONCLUSION: High clinician confidence and interest in treating chronic pain concurrent with low satisfaction with ability to provide optimal treatment suggests a need for more system support. VA primary care clinicians are frequently influenced by fears of contributing to dependence or addiction. The relationships among panel size, job satisfaction, and opioid prescribing rates merit additional investigation.

PMID: 18777608 [PubMed - in process]

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Related Articles

Choosing, deciding, or participating: what do patients want in primary care?

Br J Gen Pract. 2008 Sep;58(554):603-4

Authors: Protheroe J, Bower P

PMID: 18801274 [PubMed - in process]

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