Predictors of outcome after short-term stabilization with buprenorphine

Hillhouse, Maureen; Canamar, Catherine P; Ling, Walter

doi:10.1016/j.jsat.2012.08.016

Cited by 30 publications

(30 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adequate medication dosing that exceeds 60 mg/day for methadone (National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction, 1998) and 8 mg/day for buprenorphine (WHO, 2009), has been found to be a strong predictor of retention by multiple studies (Anderson & Warren, 2004; Hillhouse, Canamar, & Ling, 2013; Lambdin et al, 2014; Villafranca, McKellar, Trafton, & Humphreys, 2006; Wei et al, 2013), including a meta-analysis of Chinese MAT program (Bao et al, 2009) and in a recent Cochrane Review (Mattick et al, 2014); however a recent meta-analysis of OAT studies in low- and middle-income countries (Feelemyer et al, 2013) failed to confirm this association. In this study, receiving low-dose OAT was significantly correlated with lower retention, whereas the effect of medium and high OAT doses did not differ significantly.…”

Section: Discussionmentioning

confidence: 99%

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

Dumchev

Dvoryak

Chernova

et al. 2017

International Journal of Drug Policy

View full text Add to dashboard Cite

Background Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004. Methods Data from clinical records of 2,916 patients enrolled in OAT at thirteen sites from 2005–2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates. Results Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested – a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67). Conclusion Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥ 60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems.

show abstract

Section: Discussionmentioning

confidence: 99%

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

Dumchev

Dvoryak

Chernova

et al. 2017

International Journal of Drug Policy

View full text Add to dashboard Cite

show abstract

“…Older age, lifetime major depression, no history of non-oral use of opioids, and no previous opioid treatment predicted greater odds of endpoint abstinence (Dreifuss et al, 2013). Although markers of opioid use history and baseline dependence severity have predicted treatment outcome (Dreifuss et al, 2013; Hillhouse et al, 2013; Soyka et al, 2008), patients with similar levels of severity in opioid dependence or opioid use may be allocating vastly different levels of resources to obtain and use drugs. These individual differences in drug reinforcement value may be uniquely and incrementally predictive of treatment response.…”

Section: Introductionmentioning

confidence: 99%

Using behavioral economics to predict opioid use during prescription opioid dependence treatment

Worley

Shoptaw

Bickel

et al. 2015

Drug and Alcohol Dependence

Self Cite

View full text Add to dashboard Cite

Background Research grounded in behavioral economics has previously linked addictive behavior to disrupted decision-making and reward-processing, but these principles have not been examined in prescription opioid addiction, which is currently a major public health problem. This study examined whether pre-treatment drug reinforcement value predicted opioid use during outpatient treatment of prescription opioid addiction. Methods Secondary analyses examined participants with prescription opioid dependence who received 12 weeks of buprenorphine-naloxone and counseling in a multi-site clinical trial (N = 353). Baseline measures assessed opioid source and indices of drug reinforcement value, including the total amount and proportion of income spent on drugs. Weekly urine drug screens measured opioid use. Results Obtaining opioids from doctors was associated with lower pre-treatment drug spending, while obtaining opioids from dealers/patients was associated with greater spending. Controlling for demographics, opioid use history, and opioid source frequency, patients who spent a greater total amount (OR = 1.30, p < .001) and a greater proportion of their income on drugs (OR = 1.31, p < .001) were more likely to use opioids during treatment. Conclusions Individual differences in drug reinforcement value, as indicated by pre-treatment allocation of economic resources to drugs, reflects propensity for continued opioid use during treatment among individuals with prescription opioid addiction. Future studies should examine disrupted decision-making and reward-processing in prescription opioid users more directly and test whether reinforcer pathology can be remediated in this population.

show abstract

“…This NTS sample reported comparable (Hillhouse et al, 2013) or more-frequent (Soyka et al, 2008) opioid use, comparable rates of injection (Soyka et al, 2008; Hillhouse et al, 2013), higher ASI Drug Severity scores (Soyka et al, 2008), and older age at onset of heroin use (Gerra et al, 2004; Soyka et al, 2008; Hillhouse et al, 2013) than similar research studies with treatment-seeking opioid dependent samples. Although these participants denied current interest in treatment, they endorsed prior attempts to quit using heroin.…”

Section: Discussionmentioning

confidence: 60%

“…In addition, pre-treatment opioid use-related characteristics have been found to predict BUP maintenance and dose taper response in treatment-seeking opioid dependent individuals; specifically, older age at onset of opioid use (Soyka et al, 2008), shorter duration of continuous opioid use (Soyka et al, 2008), less frequent opioid use (Ziedonis et al, 2009; Warden et al, 2012; Hillhouse et al, 2013) and non-injection opioid use (Subramaniam et al, 2011) were related to positive BUP outcome (opioid-negative urine at follow-up or greater treatment retention, depending on the study).…”

Section: Introductionmentioning

confidence: 99%

Predictors of buprenorphine initial outpatient maintenance and dose taper response among non-treatment-seeking heroin dependent volunteers

Woodcock

Lundahl

Greenwald

2015

Drug and Alcohol Dependence

View full text Add to dashboard Cite

Background Buprenorphine (BUP) is effective for treating opioid use disorder. Individuals’ heroin-use characteristics may predict their responses to BUP, which could differ during maintenance and dose-taper phases. If so, treatment providers could use pre-treatment characteristics to personalize level of individual care and possibly improve treatment outcomes. Methods Non-treatment-seeking heroin-dependent volunteers (N=34) initiated outpatient BUP maintenance (8-mg/day) and submitted urine samples thrice weekly tested for opioids (non-contingent result). After completing three programmatically-related inpatient behavioral pharmacology experiments (while maintained on 8-mg/day BUP), participants were discharged and underwent a double-blind BUP dose taper (4-mg/day, 2-mg/day and 0-mg/day during weeks 1-3, respectively) with an opioid-abstinence incentive ($30 per consecutive opioid-negative urine specimen, obtained thrice weekly). Results Participants who reported less pre-study (past-month) heroin use and shorter lifetime duration of heroin use were more likely to submit an opioid-negative urine sample during initial outpatient BUP maintenance. Participants who reported more lifetime heroin-quit attempts and provided any opioid-free urine sample during initial outpatient maintenance sustained longer continuous opioid-abstinence during the BUP dose taper. Participants who reported >3 lifetime quit attempts abstained from opioid use nearly one week longer (14 vs. 8 days to opioid-lapse) and nearly half (46.7%) refrained from opioid use during dose taper. Conclusions Number of prior heroin quit attempts may predict BUP dose taper response and provide a metric for stratifying heroin-dependent individuals by relative risk for opioid lapse. This metric may inform personalized relapse prevention care and improve treatment outcomes.

show abstract

Predictors of outcome after short-term stabilization with buprenorphine

Cited by 30 publications

References 29 publications

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

Using behavioral economics to predict opioid use during prescription opioid dependence treatment

Predictors of buprenorphine initial outpatient maintenance and dose taper response among non-treatment-seeking heroin dependent volunteers

Contact Info

Product

Resources

About