Early dropout after one month of buprenorphine/naloxone maintenance therapy

*Zsolt Petke¹, Judit Mészáros², István Vingender², Zsolt Demetrovics³, Judit Farkas³, Zsuzsanna Kovács⁴, Zsuzsa Menczel⁴, Anna Havasi², Péter Simor⁵, József Rácz^1,6

Summary
Introduction. Suboxone (Buprenorphine/naloxone) is a drug used in opiate substitution therapy. In Hungary, it was introduced in November 2007. Suboxone is a product for sublingual administration containing the partial p-receptor agonist buprenorphine and antagonist naloxone in a 4:1 ratio.
Aim. Objectives of our study were to monitor and evaluate the psychosocial changes after one month of Suboxone treatment.
Material and methods. 6 outpatient centres participated in the study; 3 from Budapest and 3 from smaller cities in Hungary. At these centres, all patients entering Suboxone maintenance therapy between November 2007 and March 2008, totalling 80 persons (55 males, 35 females, mean age = 30,2 years, SD=5,48) were included in the study sample. During the 6-month period of treatment, data were collected 4 times; when entering treatment, 1 month, 3 months, and 6 months after entering treatment. Applied measure was the Addiction Severity Index.
Results. Nearly fourth of the total of 80 heroin dependent patients (18 persons, 22.5%) dropped out of treatment during the first month (the majority, 12 persons [15%] during the first week) or chose methadone substitution instead. During the first month of treatment significant positive changes were observed in all studied psychological and behavioural dimensions and proved to be stable throughout the studied period.
Conclusions. According to the experience with Suboxone treatment, it is a well tolerable and successfully applicable drug in the substitution therapy of opiate addicts. A critical phase seems to be the first one or two weeks of treatment. Dropout rate is high during this early period, whereas after a successful conversion patients presumably remain in therapy for a long period. At the beginning of administration special emphasis must be put on informing patients, especially concerning withdrawal symptoms that might be present during the first week, which highly contributes to better retention in treatment.

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