To the Editor: Dr Ling and colleagues1 provided evidence of the effectiveness of buprenorphine implants for the treatment of opioid dependence. However, as Dr O’Connor2 pointed out in his accompanying Editorial, there are barriers to this approach, and it remains to be seen whether this is more effective than the current practice of prescribing sublingual buprenorphine in an office-based setting.
In their discussion, the study authors made a case for the superiority of implants over the current approach by selectively comparing their 6-month treatment retention of 65.7% with 3 other studies with rates ranging from 33% to 38%. However, none of these studies assessed office-based treatment. One (reference 21 in the article) provided a modest maximum dose of 8 mg per day of buprenorphine; another (reference 22) was a 16-week trial followed by a 10-week taper-off treatment; and the third (reference 20) was a study of a stepped-care approach that reported a 6-month treatment retention of 77%, but approximately half of those assigned to buprenorphine switched to methadone maintenance.
In contrast, there are published studies of office-based sublingual buprenorphine treatment that report much better treatment retention rates. In the open-label phase of the landmark study by Fudala et al,3 55% of the participants received at least 6 months of treatment. In an analysis of office-based buprenorphine treatment at the Johns Hopkins Bayview Medical Center, 57% of patients remained in treatment at 12 months.4
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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