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Using Behavioral Economics to Predict Outcomes of Medication and Counseling for Prescription Opioid Dependence.

Poster presented at the College on Problems of Drug Dependence (CPDD) annual meeting, Phoenix, AZ, June 13-18, 2015.

Matthew J. Worley, MD, MPH (University of California Los Angeles, PR Node), Steven Shoptaw, PhD (University of California Los Angeles, PR Node), Warren K. Bickel, PhD (Virginia Tech Carilion Research Institute), Walter Ling, MD (University of California Los Angeles, PR Node).

Research using behavioral economics has previously linked addictive behavior to disrupted decision-making, reward-processing, and drug reinforcement value. These principles have not been examined in prescription opioid addiction, which is currently a major public health problem. This study examined whether pre-treatment drug reinforcement value predicted opioid use during outpatient treatment of prescription opioid addiction. Secondary analyses of a multi-site clinical trial (NIDA CTN-0030) for adults with prescription opioid dependence who received 12 weeks of buprenorphine-naloxone and counseling (N = 353). Analyses covaried for opioid dependence severity and opioid source. Predictors were naturalistic indices of drug reinforcement value including the total amount and proportion of income spent on drugs. Outcome was opioid use during treatment assessed by weekly urine drug screens.

Obtaining opioids from doctors was associated with lower pre-treatment drug spending, while obtaining opioids from dealers/patients was associated with greater spending. Controlling for demographics, opioid dependence severity, and opioid source frequency, patients who spent a greater total amount (OR = 1.30, p < .001) and a greater proportion of their income on drugs (OR = 1.31, p < .001) were more likely to use opioids during treatment.

Conclusions: As indicated by pre-treatment allocation of economic resources to drugs, individual differences in drug reinforcement value reflect propensity for continued opioid use during treatment among individuals with prescription opioid addiction. Future studies should examine disrupted decision-making and reward-processing in prescription opioid users more directly and test whether reinforcer pathology can be remediated in this increasingly prevalent population. (Poster, PDF, English, 2015)

Keywords: Buprenorphine/Naloxone | CTN platform/ancillary study | Decision-making | Behavioral economics | Prescription-type opiates | College on Problems of Drug Dependence (CPDD) annual meeting, 2015

Document No: 1162.

Submitted by Matthew J. Worley, MD, MPH, UCLA (7/7/2015).

Bickel, Warren K.
Ling, Walter mail
Shoptaw, Steven mail
Worley, Matthew J. mail
NIDA-CTN-0047 www

Supported by a grant from the National Institute on Drug Abuse to the University of Washington Alcohol and Drug Abuse Institute.
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Updated 7/2015 --