Buprenorphine Treatment for Opioid Addiction in the Primary Care Setting: Predictors of Treatment Success and Failure

Abstract

Buprenorphine is a partial mu-opioid agonist with well-demonstrated efficacy in the medical treatment of opioid addiction. Little is known about which patients respond successfully to treatment with buprenorphine. To help answer this question, we performed a retrospective cohort analysis of 160 patients who received outpatient buprenorphine therapy for opioid addiction at MGH Charlestown HealthCare Center. We gathered information on 36 observable patient characteristics, and searched for variables which predict early failure, late failure or success at one year. We also created predictive logistic regression models based on these data. We found that while the overall rate of retention and sobriety at one year was 43.8%, a patient’s individual chances of success varied widely, ranging from 10%-80% depending on identifiable characteristics. Independent predictors of successful response to buprenorphine included increased age (p= .0013), female sex (p= .0200), employment (p = .0131), and having negative serological studies for hepatitis C (p = .0062). In secondary analyses, we found that younger age, male sex, and unemployment specifically predict early treatment failure. Finally, we found that high early percentage positive toxicology screens, injection drug use, and failure to participate in drug counseling specifically predict late treatment failure. We conclude that certain patient populations exhibit much higher risk of failing buprenorphine treatment than others, and may require special attention and/or support in order to provide them with equal chances of attaining sobriety.