Predictors of Abstinence: National Institute of Drug Abuse Multisite Buprenorphine/Naloxone Treatment Trial in Opioid-Dependent Youth

Abstract

Objective To examine predictors of opioid abstinence in buprenorphine/naloxone (Bup/Nal) assisted psychosocial treatment for opioid dependent youth Method Secondary analyses of data from 152 youth (ages 15–21) randomly assigned to 12 weeks of extended Bup/Nal therapy or up to 2 weeks of Bup/Nal detoxification, both with weekly individual and group drug counseling. Logistic regression models were constructed to identify baseline and during-treatment predictors of opioid positive urines (OPU) at week-12. Predictors were selected based on significance or trend toward significance (i.e. p<0.1) and backward stepwise selection was used, controlling for treatment group, to produce final independent predictors at p ≤ 0.05. Results Youth presenting to treatment with past 30-day injection drug use (IDU) and more active medical/psychiatric problems were less likely to have a week-12 OPU. Those with early treatment opioid abstinence (i.e. weeks 1 and 2); and those who received additional non-study treatments during the study were less likely to have a week-12 OPU; and those not completing 12 weeks of treatment were more likely to have an OPU. Conclusions Youth with advanced illness (i.e. reporting IDU and additional health problems), and those receiving ancillary treatments to augment study treatment were more likely to have lower opioid use. Treatment success in the first 2 weeks and completion of 12 weeks of treatment were associated with lower rates of OPU. These findings suggest that youth with advanced illness respond well to Bup/Nal treatment, and identify options for tailoring treatment for opioid-dependent youth presenting at community-based settings.

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

“…It is associated with better outcomes in youth (Subramaniam et al, 2011;Woody et al, 2008) and adults (Armstrong et al 2010;Mintzer et al, 2007). Adult studies examining long term treatment with BUP/NAL revealed a 39 to 63% program retention rate at 6 months, and 53% at 1 year (Fiellin et al, 2006;Armstrong et al, 2010;Fiellin et al, 2008).…”

“…Rates of treatment retention in adolescents were reported 72% at 4-weeks in a randomized clinical trial (Marsch et al, 2005), and 50% at day 30 and 25% at day 132 in a retrospective chart review (Bell & Mutch, 2006). Opiate users aged 15-21 in BUP/NAL treatment had a 3-month retention rate of 70% in a multisite trial (Woody et al, 2008) and of 44% in a randomized trial (Subramaniam et al, 2011). Warden et al (2012) reported a treatment retention rate of 92% at 4-weeks, 78% at 8-weeks and 72% at 12-weeks in youth aged 15-21.…”

“…Abstinence was the main outcome assessed generally with negative UDS in several studies (Fiellin et al, 2008;Woody et al, 2008;Subramaniam et al, 2011;Marsch et al, 2005). Fiellin et al reported that 32% of adults patients achieved at least 9 weeks of abstinence at any point during the trial.…”

“…However, retention and abstinence during buprenorphine treatment have been associated with better outcomes in youth (Subramaniam et al, 2011;Woody et al, 2008;Matson et al, 2014) and adults (Armstrong et al, 2010;Mintzer et al, 2007). In this context, retention in treatment of opioid dependence was investigated mostly in adults, with studies lasting 6 months (O'Connor et al, 1996;Fiellin et al, 2006;Armstrong et al, 2010) and those lasting 18 months or more (Fiellin et al, 2008;Parran et al, 2010).…”

A Systematic, Intensive Statistical Investigation of Data from the Comprehensive Analysis of Reported Drugs (CARD) for Compliance and Illicit Opioid Abstinence in Substance Addiction Treatment with Buprenorphine/naloxone

“…Subramaniam et al (2011) evaluated predictors of abstinence from National Institute on Drug Abuse (NIDA) multisite bup/nal treatment trial in opioid-dependent youth. They found that youth reporting injection drug use, and those receiving adjuvant treatments for additional health problems, were more likely to have a lower opioid use.…”