Treatment completion on an inpatient detoxification unit: Impact of a change to sublingual buprenorphine-naloxone

Purpose: Buprenorphine is commonly used for opioid detoxification. The goal of this study was to determine whether a change from the intramuscular (IM) buprenorphine to the sublingual (SL) formulation of buprenorphine-naloxone was associated with improved treatment completion rates on an inpatient detoxification unit. Methods: This study was conducted at the Johns Hopkins Bayview Medical Center (JHBMC) Chemical Dependence Unit (CDU), a 26-bed, 3-day inpatient detoxification unit providing detoxification from opioids, alcohol, and sedatives. The opioid detoxification protocol was changed from IM buprenorphine (0.3 mg bid for 3 days) to SL buprenorphine-naloxone (8, 8, and 6 mg on sequential days, plus 2 mg on the morning of discharge). For the 3 months prior to and after the change in protocol, data were collected retrospectively on demographics, type of dependence being treated, and type of discharge. Findings: A total of 1,168 patients were admitted to the JHBMC CDU during the period studied. In the 3 months prior to the change in buprenorphine protocol, 353 of 483 patients admitted for treatment of opioid dependence (73.1%) completed treatment, compared with 407 of 473 patients admitted after the change (86.0%); this difference was highly significant (p < .0001). Among 212 patients who did not receive treatment for opioid dependence over the same period, the rates of treatment completion did not change significantly (89.8% before vs. 83.0% after; p = .208). Conclusions: A change from IM buprenorphine to SL buprenorphine-naloxone for opioid detoxification was associated with a significant improvement in completion rates at this inpatient treatment program.