Terry Horton, MD¹, Eric D. Collins, MD², Katherine Reinke, MS, RN¹, Edward V. Nunes, MD², and Leslie Amass, PhD³. (1) Phoenix House, 164 West 74th Street, New York, NY 10023, 914-962-2491, kreinke@phoenixhouse.org, (2) NY State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, (3) Friend's Research Center, 11075 Santa Monica Blvd, Suite 200, Los Angeles, CA 90025

Before entering residential drug treatment, most opioid-dependent patients first undergo medically supervised withdrawal, usually provided outside the residential facility. Unfortunately, many patients do not complete medically supervised withdrawal or return to the therapeutic community (TC). To improve early engagement and retention of opioid-dependent clients, Phoenix House, a traditional TC, piloted First Step, a brief in-house medically supervised opioid withdrawal, using Suboxone, within its four-week residential treatment Induction unit. Direct induction onto Suboxone (up to 16 mg) and subsequent taper occurred over about 13 days, concomitant with participation in all treatment activities of the TC program. A retrospective review of medical records was conducted on the first 37 opioid-dependent patients who entered First Step, and the results were compared to treatment outcomes of 36 controls matched on general demographics but not in need of medically-assisted opioid withdrawal. The 37 patients averaged 38.3 years of age (range 23-59) and were predominantly male (81%) and minorities (86%). Ninety-two percent (34/37) completed the Suboxone taper, and 73% (27/37) continued treatment on the Induction unit. Transfer from the Induction unit to long term TC treatment was not significantly different between Suboxone-treated patients (54%; 20/37) and controls (64%; 23/36). There were no significant Suboxone-related adverse events. These results demonstrate that brief treatment with Suboxone for opioid withdrawal can be accomplished during, and integrated with, TC residential Induction. This innovation makes it possible for more opioid-dependent patients to access TC treatment.

Learning Objectives: At the conclusion of the presentation, the participate will be able to

• Describe the critical elements of an innovative model for in-house medically supervised opiate withdrawal.
• Understand the historical context that precipitated the development of the model.
• Describe the concept of using buprenorphine/naloxone as a "treatment readiness" drug
• Discuss the initial outcomes of this model at a traditional therapeutic community
• Recognize the applicability of the model to other residential settings

Keywords: Drug Abuse Treatment, Substance Abuse Treatment

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.