Associations of methadone and buprenorphine‐naloxone doses with unregulated opioid use, treatment retention, and adverse events in prescription‐type opioid use disorders: Exploratory analyses of the OPTIMA study

Abstract

Background and ObjectivesBuprenorphine/naloxone (BUP‐NX) and methadone are used to treat opioid use disorder (OUD), yet there is insufficient evidence on the impact of doses on interventions' effectiveness and safety when treating OUD attributable to other opioids than heroin.MethodsWe explored associations between methadone and BUP‐NX doses and treatment outcomes using data from OPTIMA, a 24‐week, pragmatic, open‐label, multicenter, pan‐Canadian, randomized controlled, two‐arm parallel trial with participants (N = 272) with OUD who primarily use opioids other than heroin. Participants were randomized to receive flexible take‐home BUP‐NX (n = 138) or standard supervised methadone treatment (n = 134). We examined associations between highest BUP‐NX and methadone doses, and (1) percentage of opioid‐positive urine drug screens (UDS); (2) retention in the assigned treatment; and (3) adverse events (AEs).ResultsThe mean (SD) highest BUP‐NX and methadone dose were 17.31 mg/day (8.59) and 67.70 mg/day (34.70). BUP‐NX and methadone doses were not associated with opioid‐positive UDS percentages or AEs. Methadone dose was associated with higher retention in treatment (odds ratio [OR]: 1.025; 95% confidence interval [CI]: 1.010; 1.041), while BUP‐NX dose was not (OR: 1.055; 95% CI: 0.990; 1.124). Higher methadone doses (70–110 mg/day) offered higher odds of treatment retention.Discussion and ConclusionMethadone dose was associated with higher retention, which may be related to its full µ‐opioid receptor agonism. Future research should notably ascertain the effect of pace of titration on a wide range of outcomes.Scientific SignificanceOur results extend previous findings of high doses of methadone increasing retention to be applied in our population using opioids other than heroin, including highly potent opioids.

Brief Report: Substance Use Care Continuum in Women With and Without HIV in the Southern United States

“…For example, the optimal time for retention in SU treatment is not well-defined as evident by the range of timelines applied to analyze retention. 25,34,35 Our analysis supports the need to better understand such drop offs through future qualitative work and larger epidemiologic studies for robust data on SU and treatment patterns to develop an evidence base which can address these gaps and inform appropriate benchmarks. Future studies must investigate how achievement of benchmarks in the SU and HIV care continuums overlap and differ to guide integrated care strategies in HIV, sexual health, and primary care settings.…”

The Therapeutic Potential of Amphetamine-like Psychostimulants

“…Opioids have also been included in several clinical trials. In the treatment of opioid addiction, Methadone, a long-acting opioid agonist, is often combined with buprenorphine, a partial opioid agonist [15], or naltrexone, an opioid antagonist [16,17]. These medications help relieve withdrawal symptoms and reduce drug and alcohol cravings.…”

“…These medications help relieve withdrawal symptoms and reduce drug and alcohol cravings. Buprenorphine, in particular, reduces the risk of respiratory depression and overdose due to its ceiling effect, allowing individuals to stabilize their lives and engage in other aspects of treatment [15]. Naltrexone, on the other hand, neutralizes the pleasurable effects of opioids in the brain.…”