Frequency of Counseling Does Not Improve Outcomes for Patients Addicted to Opioids
New Haven, Conn. — Increased counseling and more frequent dispensing of medication does not improve abstinence in drug abuse treatment, according to a Yale School of Medicine study published July 27 in the New England Journal of Medicine.
“Patients who took their medication as prescribed had the best outcomes,” said the lead author of the study, David Fiellin, M.D., associate professor in the Department of Internal Medicine.
Currently, there is no standard of care for dispensing buprenorphine-naloxone to treat opioid addiction. Although physicians are required to provide counseling, or refer patients for counseling, there are no requirements specifying the type, frequency or duration. This study was designed to determine what constitutes the type and duration of effective counseling.
The study included 166 patients addicted to narcotic pain medication or heroin. Each patient was assigned to one of three treatments schedules: standard counseling with medication dispensed once a week, standard counseling with medication dispensed three times a week, or enhanced counseling with medication dispensed three times each week.
“The effectiveness of extended weekly counseling and thrice-weekly dispensing of medication is not significantly greater than brief weekly counseling and dispensing medication once weekly,” Fiellin said.
Specially trained nurses led the weekly 20- or 45-minute counseling sessions and dispensed the buprenorphine-naloxone. All of the patients met with a physician once a month. Brief counseling covered recent drug use, if any, efforts to achieve or maintain abstinence, attendance in self-help groups and the result of analysis of weekly urine specimens. The 45-minute sessions provided more in-depth drug counseling.
According to the U.S. Department of Health and Human Services low doses of buprenorphine enable opioid-addicted individuals “to discontinue the misuse of opioids without experiencing withdrawal symptoms.”
Fiellin said the U.S. Food and Drug Administration four years ago approved dispensing of buprenorphine-naloxone from doctors’ offices for the treatment of opioid dependent patients because fewer than 20 percent had access to effective treatment. While buprenorphine-naloxone can now be provided by specially trained office-based and primary care physicians, methadone used for the treatment of opioid dependent patients needs to be dispensed from specialty treatment programs according to federal regulations.
Fiellin said the study results support the use of brief and focused weekly counseling for patients who are receiving this treatment. “Patients should understand that extended counseling or thrice-weekly medication dispensing may not be needed for successful outcomes,” Fiellin said.
Co-authors include Michael Pantalon, Marek Chawarski, Brent Moore, Lynn Sullivan, M.D., Patrick O’Connor, M.D., and Richard Schottenfeld, M.D. The study was funded in part by the National Institute on Drug Abuse and the Robert Wood Johnson Foundation.
New England Journal of Medicine 355: 23-32 (July 27 2006)
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