TY - JOUR
KW - Adult
KW - Analgesics, Opioid/administration & dosage/adverse effects
KW - Boston
KW - Buprenorphine/administration & dosage/adverse effects
KW - Dose-Response Relationship, Drug
KW - Female
KW - Fentanyl/adverse effects
KW - Heroin/adverse effects
KW - Humans
KW - Male
KW - Middle Aged
KW - Opiate Substitution Treatment/adverse effects/methods
KW - Opioid-Related Disorders/drug therapy
KW - Retrospective Studies
KW - Treatment Outcome
AU - S. E. Wakeman
AU - Y. Chang
AU - S. Regan
AU - L. Yu
AU - J. Flood
AU - J. Metlay
AU - N. Rigotti
A1 - 
AB - OBJECTIVES: There has been a rapid increase in the presence of illicitly manufactured fentanyl in the heroin drug supply. Buprenorphine is an effective treatment for heroin and prescription opioid use disorder; however, little is known about treatment outcomes among people using fentanyl. We compared 6-month treatment retention and opioid abstinence among people initiating buprenorphine treatment who had toxicology positive for heroin compared to fentanyl at baseline. METHODS: Retrospective cohort study of 251 adult patients initiating office-based buprenorphine treatment who had available toxicology testing across an academic health system between August 2016 and July 2017. Exposure was assessed at baseline before initiating buprenorphine and was categorized as negative toxicology (n = 184) versus fentanyl positive toxicology (n = 48) versus heroin positive toxicology (n = 19). RESULTS: Six-month treatment retention rates were not different between the fentanyl positive and heroin positive groups [38% (n = 18) vs 47% (n = 9); P = 0.58], or between the fentanyl positive and the negative toxicology group [38% (n = 18) vs 51% (n = 93); P = 0.14]. Opioid abstinence at 6 months among those who had testing did not differ between the fentanyl positive and the heroin positive group [55% (n = 6) vs 60% (n = 6); P = 0.99]. The fentanyl positive group had a lower abstinence rate at 6 months compared to those with negative toxicology at baseline [55% (n = 6) vs 93% (n = 63); P = 0.004]. Mean initial buprenophine dosage did not differ between groups. CONCLUSIONS: Buprenorphine treatment retention and abstinence among those retained in treatment is not worse between people using fentanyl compared to heroin at treatment initiation. Both groups have lower abstinence rates at 6 months compared to individuals with negative toxicology at baseline. These findings suggest that people exposed to fentanyl still benefit from buprenorphine treatment.
AD - Division of General Internal Medicine, Massachusetts General Hospital (SEW, YC, SR, LY, JM, NR); Harvard Medical School (SEW, YC, SR, JF, JM, NR); Department of Pathology, Massachusetts General Hospital, Boston, MA (JF).
BT - Journal of addiction medicine
C5 - Opioids & Substance Use
CP - 4
CY - United States
DO - 10.1097/ADM.0000000000000486
IS - 4
JF - Journal of addiction medicine
LA - eng
M1 - Journal Article
N2 - OBJECTIVES: There has been a rapid increase in the presence of illicitly manufactured fentanyl in the heroin drug supply. Buprenorphine is an effective treatment for heroin and prescription opioid use disorder; however, little is known about treatment outcomes among people using fentanyl. We compared 6-month treatment retention and opioid abstinence among people initiating buprenorphine treatment who had toxicology positive for heroin compared to fentanyl at baseline. METHODS: Retrospective cohort study of 251 adult patients initiating office-based buprenorphine treatment who had available toxicology testing across an academic health system between August 2016 and July 2017. Exposure was assessed at baseline before initiating buprenorphine and was categorized as negative toxicology (n = 184) versus fentanyl positive toxicology (n = 48) versus heroin positive toxicology (n = 19). RESULTS: Six-month treatment retention rates were not different between the fentanyl positive and heroin positive groups [38% (n = 18) vs 47% (n = 9); P = 0.58], or between the fentanyl positive and the negative toxicology group [38% (n = 18) vs 51% (n = 93); P = 0.14]. Opioid abstinence at 6 months among those who had testing did not differ between the fentanyl positive and the heroin positive group [55% (n = 6) vs 60% (n = 6); P = 0.99]. The fentanyl positive group had a lower abstinence rate at 6 months compared to those with negative toxicology at baseline [55% (n = 6) vs 93% (n = 63); P = 0.004]. Mean initial buprenophine dosage did not differ between groups. CONCLUSIONS: Buprenorphine treatment retention and abstinence among those retained in treatment is not worse between people using fentanyl compared to heroin at treatment initiation. Both groups have lower abstinence rates at 6 months compared to individuals with negative toxicology at baseline. These findings suggest that people exposed to fentanyl still benefit from buprenorphine treatment.
PP - United States
PY - 2019
SN - 1935-3227; 1932-0620
SP - 253
EP - 257
EP - 
T1 - Impact of Fentanyl Use on Buprenorphine Treatment Retention and Opioid Abstinence
T2 - Journal of addiction medicine
TI - Impact of Fentanyl Use on Buprenorphine Treatment Retention and Opioid Abstinence
U1 - Opioids & Substance Use
U2 - 30550392
U3 - 10.1097/ADM.0000000000000486
VL - 13
VO - 1935-3227; 1932-0620
Y1 - 2019
Y2 - Jul/Aug
ER -