Counseling Requirements for Buprenorphine Maintenance in Primary Care

Objective: This preliminary study was conducted to establish the minimal counseling requirements for buprenorphine maintenance in primary care settings. A brief, nurse-administered, medically focused counseling approach for buprenorphine-maintained patients, Medical Management (MM), was designed by the authors. To evaluate preliminary feasibility and efficacy of MM prior to using it in a primary care setting, we evaluated it in a methadone maintenance program. Method: Fourteen opioid dependent patients were treated for 12 weeks with thrice-weekly buprenorphine plus either MM provided thrice weekly (5–10 minutes) by an RN, or MM plus individual Drug Counseling (MM+DC). DC was provided weekly (45 minutes) by a Ph.D.-level psychologist or a Certified Alcohol and Drug Counselor. Results: Seven of the 7 MM and 6 of the 7 MM+DC patients completed all 12 weeks of the study. Rates of opioid-positive urine toxicology tests averaged 72% for MM and 54% for MM+DC. Two of the 7 MM and 4 of the 7 MM+DC patients achieved ≥3 consecutive weeks of opioid-negative urine toxicology tests. None of these differences reached statistical significance. Conclusions: These preliminary findings demonstrate the feasibility and efficacy of MM and suggest, as with methadone, that DC may be a necessary component of buprenorphine treatment of opioid dependence. Therefore, providers of office- or primary care-based buprenorphine maintenance may need to incorporate aspects of drug counseling.