Drug and Alcohol Dependence 2015;150:112-119. [doi: 10.1016/j.drugalcdep.2015.02.030]
Roger D. Weiss, MD, Jennifer Sharpe Potter, PhD, MPH, Margaret L. Griffin, PhD, Scott E. Provost, MSW, MM, Garrett M. Fitzmaurice, ScD, Katherine A. McDermott, Emily N. Srisarajivakul, Dorian R. Dodd, Jessica A. Dreifuss, PhD, R. Kathryn McHugh, PhD, Kathleen M. Carroll, PhD (all from McLean Hospital, Harvard Medical School, NEC Node).
This is the Results Article for CTN-0030-A-3. Despite the growing prevalence of prescription opioid dependence, longitudinal studies have not examined long-term treatment response. The current study examined outcomes over 42 months in the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study (POATS, CTN-0030). POATS was a multi-site clinical trial lasting up to 9 months, examining different durations of buprenorphine-naloxone plus standard medical management for prescription opioid dependence, with participants randomized to receive or not receive additional opioid drug counseling. A subset of participants (N=375 of 653) enrolled in a follow-up study. Telephone interviews were administered approximately 18, 30, and 42 months after main-trial enrollment. Comparison of baseline characteristics by follow-up participation suggested few differences.
Results found that at Month 42, much improvement was seen: 31.7% were abstinent from opioids and not on agonist therapy; 29.4% were receiving opioid agonist therapy, but met no symptom criteria for current opioid dependence; 7.5% were using illicit opioids while on agonist therapy; and the remaining 31.4% were using opioids without agonist therapy. Participants reporting a lifetime history of heroin use at baseline were more likely to meet DSM-IV criteria for opioid dependence at Month 42. Engagement in agonist therapy was associated with a greater likelihood of illicit-opioid abstinence. Eight percent (n = 27/338) used heroin for the first time during follow-up; 10.1% reported first-time injection heroin use.
Conclusions: This was the first study to examine long-term treatment outcomes of patients with prescription opioid dependence, and results were more encouraging than short-term outcomes from POATS suggested they might be. Long-term outcomes for those dependent on prescription opioids demonstrated clear improvement from baseline. These results are consistent with research on heroin dependence in supporting the value of opioid agonist therapy for prescription opioid dependence; however, half of the follow-up participants reported good outcomes without agonist therapy as well. Additionally, a subset exhibited a worsening course, by initiating heroin use and/or injection opioid use. These data underscore the importance of longer-term follow-up in understanding the course of this increasingly prevalent substance use disorder. (Article (Peer-Reviewed), PDF, English, 2015)
Keywords: Buprenorphine/Naloxone | CTN platform/ancillary study results | Heroin | Opioid dependence | Opioid detoxification | Pharmacological therapy | Prescription-type opiates | Suboxone | Drug and Alcohol Dependence (journal)
Document No: 1132, PMID: 25818060, PMCID: PMC4407806.
Submitted by CTN Dissemination Librarians, 3/11/2015.