Patient characteristics associated with buprenorphine/naloxone treatment outcome for prescription opioid dependence: Results from a multisite study

Abstract

Background Prescription opioid dependence is a growing problem, but little research exists on its treatment, including patient characteristics that predict treatment outcome. Methods A secondary analysis of data from a large multisite, randomized clinical trial, the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study (POATS) was undertaken to examine baseline patient characteristics (N=360) associated with success during 12-week buprenorphine/naloxone treatment for prescription opioid dependence. Baseline predictor variables included self-reported demographic and opioid use history information, diagnoses assessed via the Composite International Diagnostic Interview, and historical opioid use and related information from the Pain And Opiate Analgesic Use History. Results In bivariate analyses, pre-treatment characteristics associated with successful opioid use outcome included older age, past-year or lifetime diagnosis of major depressive disorder, initially obtaining opioids with a medical prescription to relieve pain, having only used opioids by swallowing or sublingual administration, never having used heroin, using an opioid other than extended-release oxycodone most frequently, and no prior opioid dependence treatment. In multivariate analysis, age, lifetime major depressive disorder, having only used opioids by swallowing or sublingual administration, and receiving no prior opioid dependence treatment remained as significant predictors of successful outcome. Conclusions This is the first study to examine characteristics associated with treatment outcome in patients dependent exclusively on prescription opioids. Characteristics associated with successful outcome after 12 weeks of buprenorphine/naloxone treatment include some that have previously been found to predict heroin-dependent patients’ response to methadone treatment and some specific to prescription opioid-dependent patients receiving buprenorphine/naloxone.

Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

“…The common social sentiment, "Why don't these people stop doing drugs," is not just sewn into the fabric of our society, but has also permeated our healthcare system, treatment models, and our definitions of 'successful' treatment [12]. These beliefs are centered on a misguided understanding, which assumes that if a patient stops taking the opioid, then they are cured; however, this is not supported by the available evidence concerning detoxification and abstinence based treatment [13][14][15][16]. Additionally, buprenorphine/naloxone maintenance therapy has been shown to reduce rates of relapse, increase retention in treatment [17], and engage patients in psychosocial recovery models [18].…”

One-Year Follow-Up of Heroin-Dependent Adolescents Treated with Buprenorfine/Naloxone for the First Time in a Substance Treatment Unit

“…In adults with opioid dependence, associations were found between depression and retention in BUP treatment (Gerra et al, 2004;Dreifuss et al, 2013), and between more severe depression and psychopathology and attrition (Pani et al, 2000), while Warden et al (2012) reported no association between co-occurring psychiatric symptoms and attrition in youths. Also, Matson et al (2014) found no relationship between mental health problems and program retention in adolescents with opioid dependence.…”

Prescription Opioid Epidemic and Infant Outcomes

“…Given that the literature describes opioid-using populations to be at increased risk of hepatitis B, 21 hepatitis C, 21,22 HIV, 23 depression, [24][25][26] and anxiety, 27 data regarding these conditions were obtained from birth certificate data and from outpatient and hospital administrative records by using diagnostic codes (hepatitis B: 070.2x and 070.3x; hepatitis C: 070. 41 …”