Journal of Psychology & Psychotherapy
Open Access
ISSN: 2161-0487
ISSN: 2161-0487
Scott McNairy
University of Minnesota, USA
Keynote: J Psychol Psychother
Background: According to the Center for Disease Control (CDC), abuse of prescription opioids and heroin is an ever-growing epidemic in the United States. Methadone has been the long-standing treatment of choice in patients who are deemed appropriate for medication-assisted treatment (MATx) of opioid dependence. Buprenorphine/naloxone (bupe/nx) became a second option for patients in the United States suffering from opioid dependence when it received FDA approval in October 2002. The Minneapolis Veterans Affairs Health Care System (MVAHCS) started utilizing buprenorphine/naloxone therapy in 2004, in veterans with opioid dependence. Approximately, 300 veterans have received treatment with bupe/nx between 2004 and 2016. There are currently 150 veterans on active bupe/nx maintenance treatment as of 2016. The original Drug Abuse Reporting Program (DARP) outcome criteria is a 10 item rating scale that can be utilized in clinical practice to easily quantify a patient�??s treatment success or unsuccess over the course of buprenorphine/ naloxone therapy. Objectives: Primary objective of this study was to determine if treatment success is maintained after treatment discontinuation in patients who is no longer receiving buprenorphine/naloxone therapy. Secondary objective was to identify if the length of buprenorphine/naloxone therapy increases the likelihood of treatment success and to evaluate if any correlation exists between outcome success and patient participation in group therapy. Methods: Retrospective chart review and interview of patients at the MVA HCS who have received at least six months (180 days) of buprenorphine/naloxone therapy was done. A cut-off of 180 days of therapy was chosen due to previous data demonstrating universally poor outcomes in patients with less than 90 days of treatment. Conclusions: Significantly, more patients who are still on active bup/nx have a currenttime DARP score decrease of >7 compared to those who have discontinued therapy (81% vs. 16%, respectively). In those who have completed therapy, 77% of patients experienced worsened DARP scores after discontinuation, suggesting that positive results achieved while taking bup/nx may be undone when therapy is stopped. Average length of time for those retained on bup/nx treatment beyond 180 days was on therapy for an average of 334 days longer than those who discontinued therapy for any reason. However, no correlation was identified between length of bup/nx treatment and likelihood of achieving outcome success (DARP<15). Participation in group therapy was not a predictor in whether patients would experience outcome success. Utility of DARP in the clinical setting: The modified DARP scale displays great utility in the clinical setting to track global improvements in function and achievement of positive patient recovery outcomes.
Scott McNairy has 38 years of experience in the delivery of clinical health care focused on treatment for chronic pain, addictive and combat stress disorders. He is Board Certified in Addiction Psychiatry. His Post-graduate training in Psychiatric Medicine began at the Mayo Clinic (1975-1979). He is most indebted to early Mayo consultants for pioneering novel addiction and pain medicine treatment practices which serve as a foundation for his practice at the VA medical center Minneapolis.
E-mail: scottmd75@mac.com