For opioid dependent persons, inpatient detoxification (medically assisted withdrawal) often begins a period of abstinence. However, due to the chronic recurring nature of illicit opioid use, inpatient detoxification alone is inadequatefor long-term drug abstinence and improved health outcomes. Yet fewer than 50% of patients receive any aftercare-placing patients at high risk for illicit drug relapse, inattention to chroni medical problems, and high rates of health service use-emergency department visits and hospitalization. In this study, we test the potential benefits of recruiting illicit opioid users uring detoxification and linking them to primary care-based treatment with buprenorphine, an effective, evidence-based therapy for opioid dependence. We suggest that initiation of buprenorphine during inpatient detoxification, and linkage after detoxification discharge to maintenance buprenorphine in primary care practices where drug use, medical, and psychiatric disorders can be treated will reduce drug use and expensive health service use (hospitalization, ED visits) that results from medical complications of illicit drug use among opioid dependent persons. PRIMARY AIMS 1) To determine if buprenorphine, initiated during inpatient detoxification and continued after discharge (LINKAGE), will reduce illicit opioid use compared to a buprenorphine detoxification (DETOX) condition among opioid dependent drug users. 2) To determine if buprenorphine, initiated during inpatient detoxification and continued after discharge (LINKAGE) will reduce emergency department and hospital utilization compared to a buprenorphine detoxification (DETOX) condition among opioid dependent drug users. In the detoxification setting, the prevalence of opioid dependence is high, standard discharge planning yields suboptimal aftercare, patients who have chronic medical disorders and who otherwise might not seek primary medical care are accessible, and inpatient abstinence can set the stage for patients to be more receptive to longer term maintenance treatment. This proposal will test the "integrated care" paradigm recommended by the Institute of Medicine. Demonstration that the initiation of buprenorphine therapy during illicit opioid inpatient detoxification and linkage o primary care based buprenorphine providers after detoxification improves drug use and health utilization outcomes would have immediate clinical application and impact the standard of care. We believe that the implementation of this evidence-based care strategy is feasible and broadly generalizable, but rigorous examination of its value is important to impact the dissemination of this new service delivery model.

Public Health Relevance

Project Narrative Fewer than 50% of patients who seek inpatient opioid detoxification (medically assisted withdrawal) to initiate abstinence receive aftercare, placing patients at high risk for illicit drug relapse, inattention to chronic medical problems, and high rates of health service use-emergency department visits and hospitalization. In this study, we test the potential benefits of initiation of buprenorphine during inpatient detoxification and linkage after discharge to maintenance buprenorphine in primary care practices. Demonstration that this integrated care approach is superior to standard care would have immediate and generalizable clinical application, but rigorous examination of its value is important to impact the dissemination of this new service delivery model.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
1R01DA034261-01
Application #
8368464
Study Section
Special Emphasis Panel (ZDA1-GXM-A (04))
Program Officer
Denisco, Richard A
Project Start
2012-09-15
Project End
2017-07-31
Budget Start
2012-09-15
Budget End
2013-07-31
Support Year
1
Fiscal Year
2012
Total Cost
$498,068
Indirect Cost
$88,668
Name
Butler Hospital (Providence, RI)
Department
Type
DUNS #
069847804
City
Providence
State
RI
Country
United States
Zip Code
02906
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Stein, Michael; Thurmond, Portia; Bailey, Genie (2014) Willingness to use HIV pre-exposure prophylaxis among opiate users. AIDS Behav 18:1694-700
Stein, M D; Bailey, G L; Thurmond, P et al. (2014) Looking for the uninsured in Massachusetts? Check opioid dependent persons seeking detoxification. Drug Alcohol Depend 136:166-9