A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users versus a methadone clinic

Am J Med. 1998 Aug;105(2):100-5. doi: 10.1016/s0002-9343(98)00194-6.


Purpose: Buprenorphine is an alternative to methadone for the maintenance treatment of heroine dependence and may be effective on a thrice weekly basis. Our objective was to evaluate the effect of thrice weekly buprenorphine maintenance for the treatment of heroin dependence in a primary care clinic on retention in treatment and illicit opioid use.

Subjects and methods: Opioid-dependent patients were randomly assigned to receive thrice weekly buprenorphine maintenance in a primary care clinic that was affiliated with a drug treatment program (n = 23) or in a traditional drug treatment program (n = 23) in a 12-week clinical trial. Primary outcomes were retention in treatment and urine toxicology for opioids; secondary outcomes were opioid withdrawal symptoms and toxicology for cocaine.

Results: Retention during the 12-week study was higher in the primary care setting (78%, 18 of 23) than in the drug treatment setting (52%, 12 of 23; P = 0.06). Patients admitted to primary care had lower rates of opioid use based on overall urine toxicology (63% versus 85%, P < 0.01) and were more likely to achieve 3 or more consecutive weeks of abstinence (43% versus 13%, P = 0.02). Cocaine use was similar in both settings.

Conclusions: Buprenorphine maintenance is an effective treatment for heroin dependence in a primary care setting.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Ambulatory Care Facilities*
  • Buprenorphine / administration & dosage
  • Buprenorphine / therapeutic use*
  • Chi-Square Distribution
  • Cocaine / urine
  • Drug Administration Schedule
  • Female
  • Heroin Dependence / complications
  • Heroin Dependence / rehabilitation*
  • Humans
  • Male
  • Narcotic Antagonists / administration & dosage
  • Narcotic Antagonists / therapeutic use*
  • Patient Dropouts
  • Primary Health Care*
  • Statistics, Nonparametric
  • Substance-Related Disorders / complications
  • Treatment Outcome
  • United States


  • Narcotic Antagonists
  • Buprenorphine
  • Cocaine