Antidepressant treatment does not improve buprenorphine retention among opioid-dependent persons

Stein, Michael D.; Herman, Debra S.; Kettavong, Malyna; Cioe, Patricia A.; Friedmann, Peter D.; Tellioǧlu, Tahir; Anderson, Bradley J.

doi:10.1016/j.jsat.2010.05.014

Cited by 33 publications

(39 citation statements)

References 63 publications

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“…However, other authors found that a history of primary depression was not related to early attrition in cocaine misusers seeking outpatient treatment. The clinical relevance of depressive symptoms at the start of treatment was challenged, since they are in general largely transitory and do not require a specific treatment (Stein et al 2010). Consistently, in this study it was found that anxiety and depression symptoms were associated with drop-out only in initial stages of treatment and did not significantly predict failure when controlled for other variables effects (Brown et al 1998;O'Leary et al 2000).…”

Section: Discussionsupporting

confidence: 64%

Predicting Outcome in Public Addiction Services Using Data Collected During Routinely Assessment Procedures

Congia¹,

Orrù²,

Masia³

et al. 2015

Int J Ment Health Addiction

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The study examined the ability of several baseline variables to predict retention and treatment outcome in a cohort study that included 137 participants with heroin and cocaine addiction attending a public addiction service in Italy. Predictors included past drug use, intravenous use, initial urine drug screen results, cocaine and heroin craving and selfreported psychiatric symptoms. Severe depression and, in a lesser extent, anxiety symptoms, predicted lower retention. Only intravenous use was a significant predictor of cocaine use in the whole sample. Positive urine for cocaine and intravenous use predicted worse outcome among heroin addicts. Three Symptoms Checklist-90 (SCL-90) scales scores were associated with lower cocaine and heroin use. Multiple logistic regression showed that cocaine positivity and more structured psychosocial treatment predicted successful outcome. Results highlight the prognostic value of carefully assessing patterns of cocaine use and co-use, routes of administration and psychiatric symptoms at the beginning of treatment, especially in heroin addicts.For clinicians that aim to identify predictors of treatments outcomes, usefulness of knowledge from careful academic research depends on two factors: how much acquired knowledge can be exported to the context in which they work and how simple and cost effective are procedures and tools with which were produced. Regarding the first factor, unlike in research settings, public addiction services treat heterogeneous clinical samples. Mostly, patients use more than Int J Ment Health Addiction

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Section: Discussionsupporting

confidence: 64%

Predicting Outcome in Public Addiction Services Using Data Collected During Routinely Assessment Procedures

Congia¹,

Orrù²,

Masia³

et al. 2015

Int J Ment Health Addiction

View full text Add to dashboard Cite

show abstract

“…Relatedly, individuals with a history of suicide attempts were less likely to drop out of buprenorphine treatment 49 . Yet, a prospective randomized trial found that reductions in depressive symptoms among heroin users who were given escitalopram, did not predict improved retention compared to those who did not receive escitalopram 18 . Given that depressive symptoms are now part of a core symptom cluster for PTSD in the DSM-5, and that dysphoria is a common emotional state in recovery, we were interested that participants with PTSD were more likely to enter OBOT.…”

Section: Discussionmentioning

confidence: 99%

Hospitalized opioid‐dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge

et al. 2017

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Objectives Few studies have explored predictors of entry into and retention in buprenorphine treatment following linkage from an acute medical hospitalization. Methods This secondary analysis of a completed clinical trial focuses on medically hospitalized, opioid dependent patients (n=72) who were randomized to an intervention including buprenorphine induction and dose stabilization during hospitalization followed by post-discharge transition to office-based buprenorphine treatment (OBOT)). Predictors included demographics, days hospitalized, prior buprenorphine/methadone treatment, PTSD symptoms, social support, and readiness for drug use cessation. Outcome variables were treatment entry and retention (number of days in OBOT). Results Previous buprenorphine treatment, more days hospitalized, and higher PTSD symptoms predicted OBOT entry. Prior treatment, older age, and non-minority status were associated with a higher mean number of days in OBOT. Conclusions OBOT may appeal to patients who have tried buprenorphine in other settings. Linking hospitalized patients to OBOT may improve utilization of addiction treatment. Scientific Significance: Prior substance treatment, longer hospital stay, and mental health should be examined in future linkage studies.

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“…A randomized, double blind, placebo-controlled trial was conducted to determine whether escitalopram treatment of depressive symptoms begun 1 week prior to induction and continued during 12 weeks of buprenorphine treatment would improve treatment retention (Stein et al, 2010). Symptoms of erectile dysfunction were concurrently measured in male participants.…”

Section: Methodsmentioning

confidence: 99%

Change in symptoms of erectile dysfunction in depressed men initiating buprenorphine therapy

Cioe

Anderson

Stein

2013

Journal of Substance Abuse Treatment

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Aims The aim of this study is to describe the change in erectile dysfunction (ED) symptoms in the first 12 weeks of outpatient buprenorphine therapy. Background Erectile dysfunction is highly prevalent in men who use illicit opioids when compared with the general population. To date, no study has examined ED symptoms over time in men initiating buprenorphine therapy for opioid dependence. Methods A randomized, double blind, placebo-controlled trial was conducted to determine whether escitalopram treatment of depressive symptoms begun 1 week prior to buprenorphine induction would improve treatment retention. Male patients completed the International Index of Erectile Function scale at baseline prior to induction and monthly thereafter. A score of 25 or less on the erectile function domain (range 1–30) is considered indicative of erectile dysfunction. Findings A total of 111 male subjects enrolled: mean age 38.5 (± 9.7) years, 80.1% non-Hispanic Caucasian; 67.3% reported heroin as their opioid of choice. Mean IIEF at baseline was 20.4 (± 10.5). At baseline, 44.1% of the entire cohort had erectile dysfunction; among those who identified as sexually active at baseline, 26.1% had ED. Baseline erectile function was inversely and significantly correlated with age (r = −.27, p = .006), but was not associated significantly with race, heroin use, years of opioid use, smoking, or hazardous use of alcohol. Compared to baseline, mean erectile function was significantly improved (p = .001) at 3 months, and sexual desire (p = .002) improved significantly at both 2- and 3-month assessments. Conclusion Erectile dysfunction is highly prevalent in depressed males using illicit opioids. Men who remain in buprenorphine treatment for 3 months show improvement in erectile function and sexual desire.

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Antidepressant treatment does not improve buprenorphine retention among opioid-dependent persons

Cited by 33 publications

References 63 publications

Predicting Outcome in Public Addiction Services Using Data Collected During Routinely Assessment Procedures

Predicting Outcome in Public Addiction Services Using Data Collected During Routinely Assessment Procedures

Hospitalized opioid‐dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge

Change in symptoms of erectile dysfunction in depressed men initiating buprenorphine therapy

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