Study: Heroin Addiction Treatment Should Include Inpatient and Outpatient Therapy

Treatment for heroin addiction is most effective if it includes both inpatient and outpatient therapy, according to a new study.

Researchers at Boston Medical Center compared two groups of patients addicted to heroin: those who started buprenorphine treatment while in the hospital and then were referred directly to an outpatient buprenorphine treatment program, and patients who took a tapered dose of buprenorphine in the hospital to help with withdrawal, but only received referral information about local community treatment programs. Buprenorphine is an opioid substitute used to treat opioid addiction. It helps curb opioid withdrawal symptoms.

The study found 37 percent of patients in the group directed to the buprenorphine treatment program reported no illicit drug use in the month after leaving the hospital, compared with just 9 percent of those who only received general referral information, according to HealthDay. Patients in the outpatient treatment group reported fewer days of illicit drug use, and less drug use overall during the six months after they left the hospital.

The study of 139 patients appears in JAMA Internal Medicine.

“Unfortunately, referral to substance abuse treatment after discharge is often a secondary concern of physicians caring for hospitalized patients,” lead researcher Dr. Jane Liebschutz said in a news release. “However, our results show that we can have a marked impact on patient’s addiction by addressing it during their hospitalization.”

17 Responses

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    Rocky Hill MA, NCAC II, CADC II

    July 21, 2014 at 5:12 PM

    I think that this article could have been vastly improved by adding “Some” to the beginning of the title. Many opioid dependent patients have a need for short term STABILIZATION in hospital based programs, followed by a seamless transition to full service outpatient addiction programs with continuation of their OTP. Thus, patients who have medical, psychiatric or withdrawal related issues can be readied to join their families in the outpatient program while being stabilized in an acute care setting. Including the family, from the outset, is a unique opportunity of outpatient care, enhancing outcomes and giving the entire system an understanding of addictive disorders.
    Continuing to use a medical procedure that offered a 9% recovery rate vs. a 37% recovery rate, for any other medical condition, would be considered malpractice and welcome a flood of lawsuits. The question begs, why are so many inpatient programs so adamant about their disdain for using buprenorphine? It would be oversimplification if we held that it was simply bias born of avarice. It is bias, but it has many parents.

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    Ross Fishman, Ph.D.

    July 16, 2014 at 11:55 AM

    I have read only the abstract of the article in the original journal. It is an interesting study and adds a bit of knowledge to the literature but it appears to me to be totally irrelevant to the challenges facing the opioid addicted population. It is certainly of limited value to me as a long-time addiction specialist who happens to run a buprenorphine clinic as part of comprehensive outpatient substance use disorder treatment. I believe that inpatient rehabs can be helpful to some people but for the majority of opioid dependent people seeking treatment, an inpatient stay is unnecessary and a wasteful financial burden. The educational component of treatment and the induction to buprenorphine can be well accomplished in an outpatient setting. Outpatient clinics can also provide the individual counseling that inpatient rehabs often avoid. With regard to the study, tapering buprenorphine in a short-term medical setting and then merely receiving referral information without a specific referral to an outpatient facility for continuing care is poor medical care. Perhaps this work should be restricted to addiction specialists.

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    Susan Weinstock MD

    July 15, 2014 at 11:45 PM

    Agree with Anne Fletcher that the title of this article is misleading. The study does not compare efficacy of inpatient BUP detox vs. outpatient BUP detox. Would conclude that BUP maintenance reduces relapse risk, but would not draw conclusions regarding benefits of inpt. therapy.

    The fact that most residential programs do not allow medication-assisted treatment is currently a major problem with out treatment system.

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    Anne Fletcher

    July 11, 2014 at 9:32 AM

    It’s important to take a look at the study – there is a link to it right in this article. This JT article (and it’s title) is misleading. These patients did not receive inpatient drug and alcohol treatment, nor were they then placed in an outpatient addiction treatment program. They were general medical patients who were then referred for buprenorphine MEDICAL treatment, not to a structured outpatient program. Although it It did require counseling, it didn’t offer counseling within the program. I got this information from one of the study authors. In short, this study findings are not as suggested.

    Anne Fletcher, Author of Inside Rehab and Sober for Good

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    Carlos

    July 10, 2014 at 5:52 PM

    Makes no sense to me that residential treatment facilities do not offer bupernorphine, methadone and naltrexone as an option to the patients that would wanted. For too long they have bad mouth this approach ignoring the effectiveness and safety. As a result they are ill prepare to offer it. They will really need to be educated or they will make the same mistakes that MMt facilities made in the 80 and 90. Ignoring excellent federal guidelines.

    I can see them using 12 Step ideology and ignoring the research available.

    We still have a lot to learn as a profession and field.

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