Extended Outpatient Detoxification with Buprenorphine Demonstrates Better Outcomes than Short-Term Detoxification

Although outpatient detoxification with buprenorphine is widely used for opioid dependence, little research has addressed how best to maximize completion rates, reduce drug use after completion, and facilitate transition to longer term treatment. This study compared data from two consecutive studies: one among 364 individuals with opioid addiction entering 6-month treatment by receiving brief (5-day) buprenorphine detoxification, the second among 146 individuals entering 6-month treatment by receiving extended (30-day) buprenorphine detoxification.

Successful completion was defined as attending a counseling session and submitting a drug-negative urine specimen at the end of detoxification. Transition to ongoing care was defined as attending at least 1 post-detoxification counseling session. Treatment engagement was measured by the total number of counseling sessions attended and the number of drug-positive urine specimens submitted during the first 30 days of treatment.

Patients who received extended versus brief detoxification:

• Were more likely to successfully complete detoxification (16% versus 4%).
• Were more likely to transition into ongoing care (41% versus 26%).
• Attended more counseling sessions (2.9 versus 1.7) and submitted fewer drug-positive urine specimens (4.3 versus 4.8; range, 0–5) during the first 30 days of treatment.

Comments by Michael Levy, PhD
This study demonstrates that longer term detoxification with buprenorphine can increase completion rates, transitions to ongoing treatment, and treatment engagement, as well as decrease drug use in patients with opioid dependence. Programs offering detoxification with buprenorphine should consider offering longer courses. However, even with a 30-day detoxification, a substantial number of patients failed to achieve abstinence. This suggests an even longer term of detoxification with buprenorphine may be needed for many individuals, if not a maintenance regimen.