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Heroin Addiction and Related Clinical Problems: 2014, 16, 3 (pages: 87 - 98)

Induction and Switch to Buprenorphine-Naloxone in opioid dependence treatment: Predictive Value of the First Four Weeks

Apelt S.M., Scherbaum N., and Soyka M.

Summary: Background/Aims: Clinical studies report the highest risk of drop out in the first weeks of opioid dependence treatment. This secondary analysis of data from a non-interventional study with buprenorphine-naloxone (BNX) aims to evaluate the predictive value of the first four weeks for treatment outcome in routine care. Methods: Data from a multicentre 12-month study in N=337 opioid dependent patients from N=69 sites in Germany was used. Results: Patients with negative urine screenings for opiates, cocaine or benzodiazepines at screening, maximum daily dose of 8mg BNX during first four weeks, significantly lower Global Severity Index (GSI) of the SCL-90-R at day 0 and week 4 had a significantly higher chance to be retained in treatment. Patients switched from d/l-methadone, levo-methadone, buprenorphine or active heroin use differ in almost all evaluated parameters. Conclusion: The first four weeks of treatment with BNX have a high predictive value for treatment outcome especially urine screening, dosing of BNX and psychiatric distress. But the treating physician needs to determine if the patient is pre-treated with d/l-methadone, levo-methadone or buprenorphine or if the patient is induced to BNX directly from heroin, because most of the predictive values seem to be unique for a sub group of patients only.