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The Relationship Between Primary Prescription Opioid and Buprenorphine-Naloxone Induction Outcomes in a Prescription Opioid Dependent Sample.

American Journal on Addictions 2014;23(4):343-348. [doi: 10.1111/j.1521-0391.2013.12105.x]

Suzanne Nielsen, PhD (Integrated Substance Abuse Programs, University of California, PR Node), Maureen Hillhouse, PhD (Integrated Substance Abuse Programs, University of California, PR Node), Roger D. Weiss, MD (McLean Hospital, NEC Node), Larissa Mooney, MD (Integrated Substance Abuse Programs, University of California, PR Node), Jennifer Sharpe Potter, PhD, MPH (McLean Hospital, NEC Node), Joshua Lee, MD, MSc (New York University), Marc N. Gourevitch, MD, MPH (New York University School of Medicine, GNY Node), Walter Ling, MD (Integrated Substance Abuse Programs, University of California, PR Node).

This secondary analysis of data from the National Drug Abuse Institute Clinical Trials Network study CTN-0030 (Prescription Opioid Addiction Treatment Study (POATS)) aimed to compare induction experiences among participants who self-reported using one of the four most commonly reported perscription opioids (POs) and examine factors associated with difficult buprenorphine-naloxone (bup-nx) induction. The Prescription Opioid Addiction Treatment Study was a multi-site, randomized clinical trial using a two-phase adaptive treatment research design. This analysis examined bup-nx induction of participants who self-reported primary PO use of methadone, ER-oxycodone, IR-oxycodone, and hydrocodone (n=569). Analyses examined characteristics associated with difficult induction, defined as increased withdrawal symptoms measured by the Clinical Opiate Withdrawal Scale (COWS) after the first bup-nx dose with higher scores denoting greater withdrawal symptoms/severity. Contrary to the study's hypothesis, difficult induction experiences did not differ by primary PO type. Those who experienced a post-induction increase in COWS score had lower pre-dose COWS scores compared to those who did not experience a post-induction increase in COWS score (10.09 vs. 12.77). Demographics characteristics, depression, and pain history did not predict a difficult induction.

Conclusions: Difficult bup-nx inductions were not associated with participants' primary PO. Severity of withdrawal, measured with the COWS, was an important variable, reminding clinicians that bup-nx should not be commenced prior to evidence of moderate opioid withdrawal. These findings add to the evidence that with careful procedures, bup-nx can be used with few difficulties in PO-dependent patients. (Article (Peer-Reviewed), PDF, English, 2013)

Keywords: Buprenorphine | Buprenorphine/Naloxone | Clinical Opiate Withdrawal Scale (COWS) | CTN primary outcomes | Heroin | Opioid dependence | Opioid detoxification | Pharmacological therapy | Prescription-type opiates | Suboxone | Taper schedules | Archives of General Psychiatry (journal)

Document No: 1027, PMID: 24112096, PMCID: PMC4151625.

Submitted by CTN Dissemination Librarians, 10/7/2013

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