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Who Benefits from Additional Drug Counseling Among Prescription Opioid Dependent Patients Receiving Buprenorphine-Naloxone and Standard Medical Management?

Drug and Alcohol Dependence 2014;104(1):118-122
[doi: 10.1016/j.drugalcdep.2014.04.005]

Roger D. Weiss, MD (McLean Hospital, NEC Node), Margaret L. Griffin, PhD (McLean Hospital, NEC Node), Jennifer Sharpe Potter, PhD, MPH (McLean Hospital, NEC Node), Dorian R. Dodd (McLean Hospital, NEC Node), Jessica A. Dreifuss, PhD (McLean Hospital, NEC Node), Hilary Smith Connery, MD, PhD (McLean Hospital, NEC Node), Kathleen M. Carroll, PhD (Yale University School of Medicine, NEC Node).

In the multi-site Prescription Opioid Addiction Treatment Study (POATS, CTN-0030), conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN), participants randomly assigned to receive individual drug counseling in addition to buprenorphine-naloxone and medical management did not have superior opioid use outcomes. However, research with other substance dependent populations shows that subgroups of participants may benefit from a treatment even if the population as a whole did not. This study reexamined data from POATS to determine whether a subgroup of participants benefited from drug counseling in addition to buprenorphine-naloxone and medical management, either due to greater problem severity or more exposure to counseling as a result of greater treatment adherence. Problem severity was measured by a history of heroin use, higher Addiction Severity Index drug composite score, and chronic pain. Adequate treatment adherence was defined a priori as attending at least 60% of all offered sessions.

Results found that participants who had used heroin at some point in their lives and who received drug counseling were more likely to be successful (i.e., abstinent or nearly abstinent from opioids) compared to heroin users who received medical management alone, but only if they were adherent to treatment and thus received adequate exposure to counseling. Adherence and thus adequate exposure to counseling did not correlate with better outcomes in non-heroin users, and the association between severity and outcome did not vary by treatment condition for chronic pain or ASI drug severity score.

Conclusions: To the extent that a history of heroin use can be considered to be a marker of severity among patients (by virtue of its correlation with poor outcome overall), the results of this study support previous research suggesting that more severe drug dependent patients respond better to more intensive forms of treatment. However, merely being offered counseling was not sufficient to produce successful outcomes for the heroin users -- these participants had to attend counseling sessions regularly in order to achieve outcomes similar to those of non-heroin users. These findings emphasize the importance of treatment adherence, and suggest that patients with prescription opioid dependence are a heterogeneous group, with different optimal treatment strategies for different subgroups. (Article (Peer-Reviewed), PDF, English, 2014)

Keywords: Behavior therapy | Buprenorphine/Naloxone | CTN platform/ancillary study | Heroin | Opioid dependence | Pain management | Pharmacological therapy | Prescription-type opiates | Suboxone | Treatment compliance | Drug and Alcohol Dependence (journal)

Document No: 1062, PMID: 24831754, PMCID: PMC4053488.

Submitted by CTN Dissemination Librarians, 5/5/2014.

AUTHORS SEARCH LINK
Carroll, Kathleen M. search mail
Connery, Hilary Smith search
Dodd, Dorian R. search
Dreifuss, Jessica A. search mail
Griffin, Margaret L. search
Potter, Jennifer Sharpe search mail
Weiss, Roger D. search mail
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