Buprenorphine dose induction in non-opioid-tolerant pre-release prisoners. (1st November 2015)

• Record Type: Journal Article
• Authors: Vocci, Frank J.; Schwartz, Robert P.; Wilson, Monique E.; Gordon, Michael S.; Kinlock, Timothy W.; Fitzgerald, Terrence T.; O'Grady, Kevin E.; Jaffe, Jerome H.
• Is Part Of: Drug and alcohol dependence. Volume 156(2015)
• Page Start: 133
• Page End: 138
• Publication Date: 2015-11-01
• Subjects: Buprenorphine dose -- Buprenorphine induction -- Opioid-dependent prisoners; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2015.09.001
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Buprenorphine induction in non-opioid tolerant prisoners with a dependence history. Adverse events were recorded daily. There were no deaths or serious adverse events. Most common adverse events: constipation, pain, sweating, rhinorrhea and withdrawal. Abstract: Background: In a previously reported randomized controlled trial, formerly opioid-dependent prisoners were more likely to enter community drug abuse treatment when they were inducted in prison onto buprenorphine/naloxone (hereafter called buprenorphine) than when they received counseling without buprenorphine in prison (47.5% vs. 33.7%, p = 0.012) (Gordon et al., 2014 ). In this communication we report on the results of the induction schedule and the adverse event profile seen in pre-release prisoners inducted onto buprenorphine. Method: This paper examines the dose induction procedure, a comparison of the proposed versus actual doses given per week, and side effects reported for 104 adult participants who were randomized to buprenorphine treatment in prison. Self-reported side effects were analyzed using generalized estimated equations to determine changes over time in side effects. Results: Study participants were inducted onto buprenorphine at a rate faster than the induction schedule. Of the 104 (72 males, 32 females) buprenorphine recipients, 64 (37 males, 27 females) remained on medication at release from prison. Nine participants (8.6%) discontinued buprenorphine because of unpleasant opioid side effects. There were no serious adverse events reported during the in-prison phase of the study. Constipation was the most frequent symptom reported (69 percent). Conclusion: Our findings suggest that buprenorphine administered to non-opioid-tolerant adults should be started at a lower, individualized dose than customarily used for adults actively using opioids, and that non-opioid-tolerant pre-release prisoners can be successfully inducted onto therapeutic doses prior to release.