Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network prescription opioid addiction treatment study

Abstract

Background-Despite the growing prevalence of prescription opioid dependence, longitudinal studies have not examined long-term treatment response. The current study examined outcomes over 42 months in the Prescription Opioid Addiction Treatment Study (POATS).Methods-POATS was a multi-site clinical trial lasting up to 9 months, examining different durations of buprenorphine-naloxone plus standard medical management for prescription opioid dependence, with participants randomized to receive or not receive additional opioid drug counseling. A subset of participants (N=375 of 653) enrolled in a follow-up study. Telephone interviews were administered approximately 18, 30, and 42 months after main-trial enrollment. Comparison of baseline characteristics by follow-up participation suggested few differences. Results-AtMonth 42, much improvement was seen: 31.7% were abstinent from opioids and not on agonist therapy; 29.4% were receiving opioid agonist therapy, but met no symptom criteria for current opioid dependence; 7.5% were using illicit opioids while on agonist therapy; and the remaining 31.4% were using opioids without agonist therapy. Participants reporting a lifetime history of heroin use at baseline were more likely to meet DSM-IV criteria for opioid dependence at Month 42 (OR=4.56, 95% CI=1.29-16.04, p<.05). Engagement in agonist therapy was associated with a greater likelihood of illicit-opioid abstinence. Eight percent (n=27/338) used heroin for the first time during follow-up; 10.1% reported first-time injection heroin use.Conclusions-Long-term outcomes for those dependent on prescription opioids demonstrated clear improvement from baseline. However, a subset exhibited a worsening course, by initiating heroin use and/or injection opioid use.

Opioid use and dropout from extended‐release naltrexone in a controlled trial: implications for mechanism

“…Limitations of this analysis include its post‐hoc nature and the use of dropout from treatment as a proxy for relapse, used because patients were not followed‐up after dropout from treatment in this trial. Dropout is certainly a key clinical phenomenon in medication treatment of opioid use disorder, and longitudinal studies show that discontinuation of medication is associated with relapse to opioid use . Follow‐up of patients with opioid use disorder after dropout from treatment is challenging, but should be attempted in future trials of this type.…”

Evidence on the Effectiveness of Heroin-Assisted Treatment

“…For agonist therapies in particular, potential barriers to participation are varied, including negative beliefs about agonist treatments; withdrawal symptoms and unwanted side effects such as nausea, headache, obstipation, and drowsiness; treatment costs; dosing and delivery characteristics; lack of fidelity to proper implementation practices; issues with the route of administration; and lack of euphoria (Fischer et al, 2002a;Fischer et al, 2002b;Peterson et al, 2010;Soyka et al, 2008;Uebelacker et al, 2016). Some may continue to consume heroin in addition to methadone or buprenorphine (Weiss et al, 2015), though use of other sedatives (e.g., alcohol, sleeping aids, and benzodiazepines) and illicit drugs (e.g., cocaine, methamphetamine, or phencyclidine) during treatment pose greatest threat in the form of overdose or dropout from treatment. As an antagonist, naltrexone is more limited in its application, primarily appropriate for patients who have completed detoxification or have achieved abstinence during a period or incarceration or inpatient treatment and are at risk of relapse (Krupitsky et al, 2011;Lee et al, 2016;.…”

Remission from chronic opioid use—Studying environmental and socio-economic factors on recovery (RECOVER): Study design and participant characteristics

“…Despite the significant humanistic and economic burden of OUD, few publications provide information on long-term treatment outcomes for patients dependent on prescription opioids. The POATS examined long-term effects of prescription opioid dependence after patients were treated with buprenorphine-naloxone for up to 16 weeks [9,10]. The POATS measured participant (N = 375) long-term, opioid-use patterns and environmental factors (e.g., legal status, employment, and housing) for sustaining long-term abstinence over 42 months following receipt of buprenorphine and naloxone with or without drug counseling.…”