Green light for buprenorphine treatment by GPs

Buprenorphine-assisted detoxification from heroin addiction can be used with almost equal success in primary care settings by trained GPs and specialist clinics, according to research published in the current issue of the Medical Journal of Australia.

"Treatment with buprenorphine can be highly successful. It is about as effective as methadone when used as a maintenance treatment for heroin addiction," said Dr James Bell, Director of the Langton Centre at the Sydney Hospital.

The randomised trial was conducted in a specialist, outpatient drug treatment centre and six office-based general practices in inner city Sydney.

The six GPs were experienced in treating opioid-dependent patients, but had no prior experience of using buprenorphine. These GPs were provided with training and protocols for using the treatment.

The trial tracked the progress of 115 people seeking treatment for heroin dependence. Ninety-seven of these people were reinterviewed at Day 8, and 78 people were reinterviewed at Day 91.

The trial included people dependent on heroin, aged between 16 and 65 years who had stable accommodation within a 6km radius of the clinic.

"Participants were randomly allocated to primary care or a specialist clinic, and received buprenorphine for 5 days for detoxification, then were offered either maintenance therapy with methadone or buprenorphine, relapse prevention with naltrexone, or counselling alone," Dr Bell said.

"While the study sought to assess the short-term effectiveness of buprenorphine in detoxification from heroin, it also measured participation in follow-up treatment.

"Successful withdrawal from heroin, without follow-up treatment, is followed by a high likelihood of relapse to heroin use within 12 months," Dr Bell said.

"In our study, 64 of the 115 participants (56 percent) entered post-withdrawal treatment, mostly buprenorphine maintenance, and 40 of the 115 participants were still in treatment at Day 91.

"Outcomes in both the clinic setting and primary care were very similar. The cost of buprenorphine detoxification in primary care was estimated to be $24 more per patient than treatment at the clinic.

"Our findings suggest that buprenorphine treatment for heroin dependence, involving general practitioners and retail pharmacists to supply the drug and supervise the dosing, can be initiated safely, effectively and with similar cost-effectiveness as treatment in specialist clinics," Dr Bell said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT: Dr James Bell, 0402 012 756(Weekend) 02 93328703 (Monday)

Judith Tokley, AMA, 0408 824 306