Factors limiting successful buprenorphine treatment with inner city heroin users: A patient survey

OBJECTIVES: Little is known about barriers to maintenance outpatient buprenorphine treatment specific to inner city heroin addicts. We identified potential barriers to implementation of outpatient treatment with buprenorphine in an inner city population. METHODS: Twenty-one patients admitted to a community teaching hospital with acute heroin use were identified in 1 month in 2005. Each patient was interviewed using a survey that evaluated familiarity with buprenorphine, heroin use, and obstacles to quitting. RESULTS: All 21 patients agreed to participate. Mean age was 45 years. Patients had used heroin for an average of 18 years (range, 1 to 40‰y). Personal cost for heroin ranged from $40 to $200/d, with some patients using occasionally and others daily. Eight patients had been incarcerated, and 8 reported being homeless. All patients expressed interest in quitting heroin. Five of twenty-one patients reported being encouraged by a healthcare provider to obtain buprenorphine maintenance therapy; only one described this encouragement as enthusiastic. Cost of buprenorphine was cited as an obstacle by 13 patients. CONCLUSIONS: Lack of healthcare worker referral and cost of treatment were major obstacles to implementation of buprenorphine outpatient maintenance treatment for inner city heroin users.