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Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting

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Abstract

Context

Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients.

Objective

To characterize the feasibility of OBOT-B in homeless relative to housed patients.

Design

A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior.

Results

Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P = .94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5–1.7) P = .8], utilization of counseling (homeless, 46%; housed, 49%; P = .95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P = .96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients.

Conclusions

Despite homeless opioid dependent patients’ social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment.

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Acknowledgements

Preliminary results of this study were presented at the 28th annual meeting of the Society of General Internal Medicine in New Orleans on May 11–14, 2005, the 67th annual national meeting of the College on Problems of Drug Dependence in Orlando, FL on June 18–23, 2005, and at the 29th annual meeting of the Association for Medical Education and Research in Substance Abuse in Bethesda, MD on October 27–29, 2005. Data management was provided by Michael Winter MPH and Jacqueline Ashba MA, MPH, at the Data Coordinating Center, Boston University School of Public Health, Boston, MA. Support for these programs and their evaluation was provided by the Massachusetts Department of Public Health: Bureau of Substance Abuse Services and HIV/AIDS Bureau.

Potential Financial Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 91 E. Concord Street, Suite 200, Boston, MA, 02118, USA

    Daniel P. Alford MD, MPH, Colleen T. LaBelle, Jessica M. Richardson, Debbie M. Cheng ScD & Jeffrey H. Samet MD, MA, MPH

  2. Boston University School of Medicine, Boston, MA, USA

    Daniel P. Alford MD, MPH & Jeffrey H. Samet MD, MA, MPH

  3. Boston Public Health Commission, Boston, MA, USA

    Daniel P. Alford MD, MPH & Colleen T. LaBelle

  4. Boston Health Care for the Homeless Program, Boston, MA, USA

    James J. O’Connell MD & Carole A. Hohl MHS

  5. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    Debbie M. Cheng ScD

  6. Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA, USA

    Jeffrey H. Samet MD, MA, MPH

Authors
  1. Daniel P. Alford MD, MPH
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  2. Colleen T. LaBelle
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  3. Jessica M. Richardson
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  4. James J. O’Connell MD
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  6. Debbie M. Cheng ScD
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  7. Jeffrey H. Samet MD, MA, MPH
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Correspondence to Daniel P. Alford MD, MPH.

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Alford, D.P., LaBelle, C.T., Richardson, J.M. et al. Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting. J GEN INTERN MED 22, 171–176 (2007). https://doi.org/10.1007/s11606-006-0023-1

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