Scott McNairy
University of Minnesota, USA
Title: Buprenorphine/Naloxone Treatment Outcomes – A 12 Year Experience at the Minneapolis VAHCS
Biography
Biography: Scott McNairy
Abstract
BACKGROUND
According to the Center for Disease Control (CDC), abuse of prescription opioids and heroin is an ever-growing epidemic in the United States
Methadone has been the long-standing treatment of choice in patients who are deemed appropriate for medication-assisted treatment (MATx) of opioid dependence
Buprenorphine/naloxone (bupe/nx) became a second option for patients in the United States suffering from opioid dependence when it received FDA approval in October 2002
The Minneapolis Veterans Affairs Health Care System (MVAHCS) started utilizing buprenorphine/naloxone therapy in 2004 in veterans with opioid dependence
Approximately 300 veterans have received treatment with bupe/nx between 2004 and 2016
There are currently 150 veterans on active bupe/nx maintenance treatment as of 2016
The original Drug Abuse Reporting Program (DARP) outcome criteria is a 10 item rating scale that can be utilized in clinical practice to easily quantify a patient’s treatment success or unsuccess over the course of buprenorphine/naloxone therapy 1
OBJECTIVES
Primary Objective:
Determine if treatment success is maintained after treatment discontinuation in patients no longer receiving buprenorphine/naloxone therapy
Secondary Objectives:
Identify if the length of buprenorphine/naloxone therapy increases the likelihood of treatment success
Evaluate if any correlation exists between outcome success and patient participation in group therapy
METHODS
Retrospective chart review and interview of patients at the MVAHCS who have received at least six months (180 days) of buprenorphine/naloxone therapy. A cut-off of 180 days of therapy was chosen due to previous data demonstrating universally poor outcomes in patients with less than 90 days of treatment. 2
Obtain demographic information and modified DARP ratings:
Two DARP scores in patients currently receiving therapy:
At treatment initiation
Current score within the past three months
Three DARP scores in patients no longer receiving therapy:
At treatment initiation
When treatment was completed
Current score within the past three months
Inclusion Criteria: on buprenorphine/naloxone for >6 months
Exclusion Criteria: lost to follow-up
CONCLUSIONS
Significantly more patients who are still on active bup/nx have a current-time DARP score decrease of > 7 compared to those who have discontinued therapy (81% vs. 16%, respectively)
In those who have completed therapy, 77% of patients experienced worsened DARP scores after discontinuation, suggesting that positive results achieved while taking bup/nx may be undone when therapy is stopped
Average length of time for those retained on bup/nx treatment beyond 180 days were on therapy for an average of 334 days longer than those who discontinued therapy for any reason; however, no correlation was identified between length of bup/nx treatment and likelihood of achieving outcome success (DARP < 15)
Participation in group therapy was not a predictor in whether patients would experience outcome success
Utility of DARP in the Clinical Setting
The modified DARP scale displays great utility in the clinical setting to track global improvements in function and achievement of positive patient recovery outcomes
Study Limitations
More than half of the patients who completed or discontinued therapy identified both heroin and prescription opioids as their drug of choice prior to treatment, while only 31% of patients on active therapy reported both as their drugs of choice.