Journal of Substance Abuse Treatment 2015;50:32-37. [doi: 10.1016/j.jsat.2014.10.003]
Gvantsa Piralishvili, MD, PhD (Centre for Mental Health and Prevention of Addiction, Tbilisi, Georgia), David Otiashvili, MD, PhD (Addiction Research Center, Altnerative Georgai, Tbilisi), Zura Sikharulidze, MD, PhD (Medical Centre Uranti, Tbilisi), George Kamkamidze, MD (Health Research Union, Tbilisi), Sabrina A. Poole, MS (Treatment Research Institute, DV Node), George E. Woody, MD (Treatment Research Institute, DV Node).
This study, supported in part by a CTN Invest Fellowship awarded to the first author, aimed to assess the prevalence of non-opioid drug use among opioid-addicted buprenorphine injecting individuals in Georgia (former Soviet republic), during and after a 12-week course of buprenorphine-naloxone (Suboxone) or methadone. This randomized, controlled trial used daily observed Suboxone or methadone and weekly counseling, urine tests, and Timeline Followback (TLFB) in weeks 0-12, and 20, as well as the Addiction Severity Index (ASI) at weeks 0, 4, 8, 12, and 20. Of the 80 patients (40/group, 4 women), 68 (85%) completed the 12 weeks of study treatment and 66 (82.5%) completed the 20 week follow-up.
At baseline, injecting more than one drug in the last 30 days was reported by 68.4% of patients in the methadone and 72.5% in the Suboxone groups. Drug use was markedly reduced in both treatment conditions, but there were significant differences in the prevalence of specific drugs with more opioid (1.5 vs. 0.2%; p = 0.03), less amphetamine (0.2 vs. 2.8%; p < 0.001) and less marijuana (1.7 vs. 10.2%; p < 0.001) positive urine tests in the methadone vs. Suboxone groups. At the 20 week follow-up, TLFB results on the 34 that continued methadone or the 3 on Suboxone showed less opioid (5.6 vs. 27.6%; p < 0.001), illicit buprenorphine (2.7 vs. 13.8%; p = 0.005), benzodiazepine (13.5 vs. 34.5%; p < 0.001), and marijuana (2.8 vs. 20.7%; p < 0.001) use than the 29 who did not continue opioid substitution therapy.
Conclusions: Daily observed methadone or buprenorphine-naloxone therapy with weekly counseling was markedly effective in reducing not only opioid use, but use of other psychoactive substances in Georgia, though there was more non-opioid use in patients treated with Suboxone, and more opioid use in patients treated with methadone. As in other settings, stopping opioid substitution therapy was associated with relapse to non-prescribed and other drug use. (Article (Peer-Reviewed), PDF, English, 2015)
Keywords: Amphetamines | Buprenorphine/Naloxone | Heroin | Injection drug use | INVEST/CTN Fellowships | Methadone maintenance | Pharmacological therapy | Suboxone | Subutex | Journal of Substance Abuse Treatment (journal)
Document No: 1153, PMID: 25456093.
Submitted by George Woody, MD, Treatment Research Institute, DV Node.