There has been a lot of discussion about the use of buprenorphine to treat addiction and prevent overdose.
I’ve pointed out that weak retention rates weaken this rationale.
One common response is that the treatment system and recovering community reinforce stigma associated with maintenance medications and undermine outcomes, including retention.
This makes retention findings from other countries and cultures of interest.
The Journal of Substance Abuse Treatment just published a report on a small study of buprenorphine maintenance retention in young adults in India.
First, a natural question is, “What does treatment look like in India?”
The current study was conducted at an apex (tertiary level) substance use disorder treatment centre from the northern part of India. It is a WHO Collaborating Centre on Substance Abuse. The facility is a 50 bedded centre which is involved in providing clinical services, capacity building, conducting research, and guiding policy decisions for addiction related issues in India. The centre offers both inpatient and outpatient treatment, along with services for psychotherapeutic interventions and psycho-social rehabilitation.
Patients are primarily admitted at the centre for opioid and alcohol detoxification. The duration of admission is typically for 2–3 weeks. During the inpatient stay, patients are provided medications for symptomatic management of withdrawal symptoms. Medications for detoxification at the centre typically include benzodiazepines for alcohol use disorders and buprenorphine for opioid use disorders. After detoxification, the patients are started on medications for long term phase. Treatment for co-occurring psychiatric disorders is also provided (Sarkar, Balhara, Gautam, & Singh, 2016).
The centre offers maintenance therapy for opioid use disorders in form of buprenorphine (including buprenorphine-naloxone combination) (Balhara & Jain, 2012; Prakash & Balhara, 2016). Buprenophine induction can occur in the out-patient as well as in-patient setting. After initial period of dose stabilization buprenorphine is dispensed on a daily basis for a period of three months. Subsequently, the patient is shifted to take home doses of buprenorphine-naloxone combination that is dispensed on a biweekly basis, before shifting the patients to a weekly dispensing regimen. The earlier practice of alternate day dispensing (dose for two days administered on one day and the patient shall visit on alternate day) has been discontinued at the centre before the data collection period for the current study (Balhara, 2014). The patients are also provided counseling and rehabilitation services. These interventions are more intensive in the in-patient setting as compared to the out-patient setting.
What did they find?
The current study found the retention rates on buprenorphine maintenance to be 33.8% at 90 days, 19.11% at 6 months and 11.8% at 12 months.
See other posts about buprenorphine findings here.
As I’ve said many times, none of this is to suggest that buprenorphine should not be available to any patient who chooses it. It’s just a push for good informed consent that empowers patients to advocate and choose for themselves.