REVIEW OF: Du CX et al, Fam Pract 2022;39(2):234–240       

STUDY TYPE: Retrospective review        

There is a belief that patients taking medications for opioid use disorder (MOUD) are “complicated.” As a result, outpatient providers might be reluctant to prescribe MOUD, fearing that their practice will fill up with difficult patients. But are these patients actually more complicated? A recent study suggests that the answer is no, at least in some respects.        

Much has been written about office-based opioid treatment (OBOT) with buprenorphine, mostly in primary care, but less is known about the medical and psychiatric comorbidities of the patients who receive this treatment. Researchers conducted a retrospective chart review to determine the needs of patients enrolled in a community-based nonprofit OBOT clinic that provides primary care services. They reviewed the most recent clinic note and the last three months of urine toxicology results for all patients actively enrolled in the clinic on or before April 2019. Patients did not have to be enrolled for a given length of time to be included. Charts were excluded if patients had not received medical care at the clinic or were not prescribed buprenorphine.        

A total of 355 charts were included in the analysis. Study participants were mostly male (71.2%) and White (89%). A third (33.7%) were ≥50 years old, and two-thirds (66.1%) had been in treatment for at least one year. Common comorbidities were other substance use disorders (54.8%), psychiatric conditions (38.5%), and chronic pain (24.5%). Many (82.3%) were taking at least one medication in addition to buprenorphine, most commonly psychotropics (59.4%), particularly antidepressants (36.6%), cardiovascular medications (36.6%), and nonopioid analgesics (22.5%). The percentage of patients receiving five or more prescriptions was higher than the general US adult population (40.3% vs 15%); however, the clinical indications and types of medications were similar (Kantor ED et al, JAMA 2015;314(17):1818–1831).        

As a group, the participants were remarkably adherent, with 99.4% testing positive for prescribed buprenorphine and just 7.8% testing positive for nonprescribed opioids. Patients were not more likely to test positive for other opioids even if they had chronic pain, had psychiatric disease, or were younger. Rates of transmissible infections were low—no participants were diagnosed with HIV, and only 7.04% were diagnosed with viral hepatitis. The only factor associated with treatment retention of less than one year was a history of having an opioid-positive urine.        

The study was limited to the medical record of this specific clinic, so some medical data may not have been adequately captured. Likewise, some important outcomes were not reported, including rate of overdose, discharge from the clinic, transition to methadone, and overall patient mortality.        

Carlat Take        

The medical comorbidities of patients receiving OBOT in this study were similar to those of the general US adult population and within the scope of most primary care providers. Patients with high-risk features such as younger age, psychiatric comorbidity, and chronic pain did just as well with buprenorphine OBOT as anyone else. The study was limited to an addiction treatment facility with embedded primary care services, so how this patient population compares to the inverse—a general primary care facility that offers OBOT—is unknown.