A naturalistic longitudinal analysis of post‐detoxification outcomes in opioid‐dependent patients

Ivers, Jo-Hanna; Zgaga, Lina; Sweeney, Brion; Keenan, Eamon; Darker, Catherine; Smyth, Bobby P; Barry, Joe

doi:10.1111/dar.12597

Cited by 9 publications

(5 citation statements)

References 33 publications

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“…2018), because it is associated with a high rate of relapse relative to OMT (Weiss et al 2011;Fiellin et al 2014). Specifically, attrition is higher among patients undergoing supervised withdrawal relative to maintenance treatments (Fiellin et al 2014), and relapse within 30 days of withdrawal is common in the absence of relapse prevention efforts (Ivers et al 2017). This is particularly problematic because reductions in opioid tolerance can increase the risk of opioid-related overdose (Wines et al 2007).…”

Section: Introductionmentioning

confidence: 99%

Preliminary evidence of different and clinically meaningful opioid withdrawal phenotypes

et al. 2018

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Background: Opioid use disorder (OUD) is a public health crisis. Differences in opioid withdrawal severity that predict treatment outcome could facilitate the process of matching patients to treatments.Methods: This is a secondary analysis of a randomized controlled trial (RCT;Dunn et al., 2017) that enrolled treatment-seeking primary heroin users (N=89; males=78) into a residential study. Participants maintained on morphine (30mg, SC, QID) underwent a naloxone (0.4mg, IM) challenge session to precipitate withdrawal. Area-under-the-curve (AUC) values from selfreported withdrawal ratings during the challenge session were analyzed using K-means clustering, revealing 2 phenotype groups. Withdrawal and retention from the subsequent 14-day double-blind, double-dummy RCT comparing 3 study medications (clonidine, tramadol-ER, buprenorphine) were evaluated as a function of phenotype.Results: Cluster analyses suggested HIGH (N=37; mean[SD] SOWS-AUC 123.7[65.8]) and LOW (N=52; SOWS-AUC 68.0 [47.7]) withdrawal phenotype groups. HIGH participants were significantly more female and had lower body mass indices than LOW participants; no drug use variables were significant. Regarding RCT outcomes, HIGH phenotype participants were less likely to be retained in the study (p=0.02) and had higher mean self-reported withdrawal (p=0.05) than LOW phenotype participants. A significant interaction in RCT retention was observed between phenotype (p=0.02) and study medication (p<.01). Self-reported withdrawal was significant for phenotype (p=0.02); study medication trended towards significance (p=0.07). Conclusions:Results suggest patients have meaningfully different experiences of opioid withdrawal that may predict differential response to opioid pharmacotherapies during supervised withdrawal. Additional prospective research to replicate and more thoroughly evaluate withdrawal phenotype correlates and sex differences is warranted.

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Section: Introductionmentioning

confidence: 99%

Preliminary evidence of different and clinically meaningful opioid withdrawal phenotypes

et al. 2018

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“…Time to lapse or relapse was significantly shorter for patients with no formal aftercare (HR 7.7; 95% CI, 4. [3][4][5][6][7][8][9][10][11][12][13][14]. Limitations included possible recall bias, lack of data on the no formal aftercare group because of their high dropout rate (69% at 9 months), and lack of long-term data.…”

Section: Evidence-based Answermentioning

confidence: 99%

“…A 2018 observational study (n=58) evaluated the effects of post-inpatient detoxification aftercare. 3 Patients (72% male, average age of 31 years old) were placed in inpatient aftercare, outpatient aftercare, or no formal aftercare groups. Outpatient aftercare lasted 12 to 24 weeks and took either an educational or a vocational approach.…”

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confidence: 99%

Does outpatient monitoring of opioid-dependent patients after release from an inpatient rehabilitation help prevent relapses/overdoses?

Donovan

Baltes

Jacobs

2021

EBPR

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“…Across five states in the US, detoxification patients who received addiction treatment within 14 days were less likely to be readmitted to detoxification in the same year than those who did not receive addiction treatment (for example, in Connecticut, 14% with treatment were readmitted, versus 24% without treatment; Lee et al, 2014). Indeed, patients who sustain prolonged abstinence and related positive outcomes after detoxification are distinguished by having been in treatment and/or mutual-help (Carroll et al, 2009;Chutuape et al, 2001;Ford & Zarate, 2010;Ivers et al, 2017).…”

Section: Treatment and Outcomes Among Detoxification Inpatientsmentioning

confidence: 99%

Randomized controlled trial of enhanced telephone monitoring with detoxification patients: 3- and 6-month outcomes

Timko

Below

Vittorio

et al. 2019

Journal of Substance Abuse Treatment

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Telehealth interventions have the potential to deter repeated detoxification episodes and improve outcomes. Using a sample of 298 detoxification inpatients, this randomized controlled trial compared Enhanced Telephone Monitoring (ETM) to usual care (UC) on the primary outcome of reducing subsequent detoxification, and secondary outcomes of linking patients to addiction treatment and mutual-help, and patients' experience of improved substance use and mental health outcomes. At the 3-month follow-up (i.e., at the end of the ETM intervention), compared to UC patients, ETM patients were significantly less likely to have received additional inpatient detoxification, but no more likely to have participated in 12-step groups or received outpatient addiction treatment. Even so, ETM patients had better alcohol, drug, and mental health outcomes. In contrast, at the 6-month follow-up, patients in ETM and UC generally did not differ on primary or secondary outcomes. Findings suggest that ETM deters additional detoxification episodes while the intervention is ongoing, but not after the intervention ends. Because telephone monitoring is low-intensity and low-cost, its extension over time may help reduce repeated detoxifications.

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A naturalistic longitudinal analysis of post‐detoxification outcomes in opioid‐dependent patients

Abstract: Patients who opt for aftercare post-detoxification have significantly better outcomes at follow up when compared to no formal aftercare. In addition, patients' intention to attend aftercare affected their outcomes regardless of eventual treatment path.

Cited by 9 publications

References 33 publications

Preliminary evidence of different and clinically meaningful opioid withdrawal phenotypes

Preliminary evidence of different and clinically meaningful opioid withdrawal phenotypes

Does outpatient monitoring of opioid-dependent patients after release from an inpatient rehabilitation help prevent relapses/overdoses?

Randomized controlled trial of enhanced telephone monitoring with detoxification patients: 3- and 6-month outcomes

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