Journal of Clinical Psychiatry 2015;76(2):189-194. [doi: 10.4088/JCP.14m09096]
Katherine A. McDermott (McLean Hospital, NEC Node), Margaret L. Griffin, PhD (Harvard Medical School, NEC Node), Hilary S. Connery, MD, PhD (McLean Hospital, NEC Node), E. Yvette Hilario (McLean Hospital, NEC Node), David A. Fiellin, MD (Yale University, NEC Node), Garrett M. Fitzmaurice, ScD (McLean Hospital, NEC Node), Roger D. Weiss, MD (Harvard Medical School, NEC Node).
Initial medication response has been shown to predict treatment outcome across a variety of substance use disorders, but no studies have examined the predictive power of initial response to buprenorphine-naloxone (BUP-NAL) in the treatment of prescription opioid dependence. This secondary analysis of data from the National Drug Abuse Treatment Clinical Trials Network's Prescription Opioid Addiction Treatment Study aimed to determine whether initial response to BUP-NAL predicted 12-week treatment outcome in a prescription opioid-dependent population. Outcomes were determined from the Substance Use Report, a self-report measure of substance use, and confirmatory urinalysis. Predictive values were calculated to determine the importance of abstinence versus use at various time points within the first month of treatment (week 1, weeks 1–2, 1–3, or 1–4) in predicting successful versus unsuccessful treatment outcome (based on abstinence or near-abstinence from opioids) in the last 4 weeks of BUP-NAL treatment (weeks 9–12).
Results found that outcome was best predicted by medication response after 2 weeks of treatment. Two weeks of initial abstinence was moderately predictive of treatment success (positive predictive value = 71%), while opioid use in both of the first 2 weeks was strongly predictive of unsuccessful treatment outcome (negative predictive value [NPV] = 84%), especially when successful outcome was defined as total abstinence from opioids in weeks 9-12 (NPV = 94%).
Conclusions: To assess the importance of early treatment response to buprenorphine-naloxone stabilization, this study used predictive values to examine the degree to which initial response to BUP-NAL treatment could predict 12-week outcome in a large prescription opioid-dependent sample. It was found that an eventual poor treatment outcome could be identified with a high degree of accuracy after just 2 weeks of BUP-NAL treatment. Even opioid use in week 1 was a fairly poor prognostic sign, predicting an 80% likelihood that a participant would be unable to abstain from opioids in weeks 9-12. This points out the importance of very early response to treatment in this population. The sooner we can identify likely eventual outcomes based on initial experience with BUP-NAL, the sooner treatment can be tailored more specifically to patients' individual needs. Additionally, early identification of patients who are likely to do poorly may make treatment more efficient and cost-effective, an important aim in light of the economic burden of prescription opioid dependence. (Article (Peer-Reviewed), PDF, English, 2014)
Keywords: Buprenorphine/Naloxone | CTN platform/ancillary study | Opioid dependence | Outcome predictors | Pharmacological therapy | Prescription-type opiates | Journal of Clinical Psychiatry (journal)
Document No: 1117, PMID: 25562462, PMCID: PMC4352119.
Submitted by CTN Dissemination Librarians, 1/14/2015.