The value of ongoing evaluation in adopting buprenorphine-naloxone short-term taper.

Buprenorphine-naloxone (BNX) tablet treatment for opioid dependence became available for clinical use in the U.S. in January 2003. Before BNX approval, a large randomized clinical trial of short-term use of BNX for medically supervised withdrawal from opioids was completed by the NIDA Clinical Trials Network (protocol CTN-0001, “Buprenorphine/Naloxone versus Clonidine for Inpatient Opiate Detoxification”). Maryhaven, a community treatment provider, had a favorable experience in the study and decided to use a similar short-term BNX treatment for withdrawing patients from opioids over 2 to 3 weeks. This presentation utilizes results from a retrospective chart review to describe their research-to-practice experience and clinical outcomes from 64 opioid-dependent patients enrolled in Maryhaven’s BNX programming, which includes direct, residential induction onto 8-32 mg of BNX followed by tapering doses and transfer to additional short-term residential care or supervised ambulatory detoxification. Patients are encouraged to continue with treatment beyond the BNX taper. Most patients (84%) completed the BNX taper and also engaged in treatment beyond detoxification. The BNX taper completion rate represents a substantial improvement over the historical 56% completion rate of clonidine detoxification available before the BNX program. While these patient outcomes were impressive ongoing feedback was required to maintain the treatments effectiveness when shorter tapers were found to be effective at managing withdrawal but not at facilitating continued treatment. Since detoxification alone is not an effective treatment for opiate dependence, it is possible to improve detoxification completion rates without improving treatment.

This presentation describes the adoption of a scientifically proven efficacious treatment by community treatment provider and will highlight the need for ongoing evaluation and feedback to guide the adaptation of the intervention, maintain targeted outcomes and, provide continued incentives to maintain the new practice.