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Treatment Outcomes in Opioid Dependent Patients with Different Buprenorphine/Naloxone Induction Dosing Patterns and Trajectories

American Journal on Addictions 2015;24:667-675. [doi: 10.1111/ajad.12288]

Petra Jacobs, MD (EMMES Corporation), Alfonso Ang, PhD (UCLA, PR Node), Maureen P. Hillhouse, PhD (UCLA, PR Node), Andrew J. Saxon, MD (VA Puget Sound Health Care, PN Node), Suzanne Nielsen, PhD (University of New South Wales, Australia), Paul G. Wakim, PhD (NIDA Center for the Clinical Trials Network), Barbara E. Mai, PhD (Uniformed Services University of the Health Sciences, MD), Larissa J. Mooney, MD (UCLA, PR Node), Jennifer Sharpe Potter, PhD, MPH (University of Texas, TX Node), Jack D. Blaine, MD (NIDA Center for the Clinical Trials Network).

Induction is a crucial period of opioid addiction treatment. This study aimed to identify buprenorphine/naloxone (BUP) induction patterns and examine their association with outcomes (opioid use, retention, and related adverse events [AEs]). Using data from the NIDA Clinical Trials Network study Starting Treatment with Agonist Replacement Therapies (START) (CTN-0027), this study involved 740 participants inducted on BUP with flexible dosing, receiving treatment in 8 treatment settings. Latent class analysis models detected six distinctive induction trajectories: bup1 started and remained on low; bup2 started low, shifted slowly to moderate; bup3 started low, shifted quickly to moderate; bup4 started high, shifted to low; bup5 started and remained on moderate; and bup6 started moderate, shifted to high dose.

Baseline characteristics, including Clinical Opioid Withdrawal Scale (COWS), were important predictors of retention. When controlled for the baseline characteristics, bup6 participants were three times less likely to drop out the first 7 days than bup1 participants. Opioid use and AEs were similar across trajectories. Participants on greater-than-or-equal-to 16mg BUP compared to those on less than 16mg at Day 28 were less likely to drop out and less likely to experience AEs during the first 28 days.

Conclusions: BUP induction dosing was guided by an objective measure of opioid withdrawal. Participants with higher baseline COWS whose BUP doses were raised more quickly were less likely to drop out in the first 7 days than those whose doses were raised more slowly. This study supports the use of an objective measure of opioid withdrawal (COWS) during BUP induction to improve retention early in treatment. (Article (Peer-Reviewed), PDF, English, 2015)

Keywords: Adverse events | Buprenorphine/Naloxone | Clinical Opiate Withdrawal Scale (COWS) | CTN platform/ancillary study | Buprenorphine/Naloxone | Opioid dependence | Retention - Treatment | Suboxone | American Journal on Addictions (journal)

Document No: 1164, PMID: 26400835, PMCID: PMC5322942

Submitted by Jack Blaine, MD, CCTN, 8/18/2015.


Ang, Alfonso mail
Blaine, Jack D. mail
Hillhouse, Maureen P. mail
Jacobs, Petra
Mai, Barbara E.
Mooney, Larissa J. mail
Nielsen, Suzanne
Potter, Jennifer Sharpe mail
Saxon, Andrew J. mail
Wakim, Paul G. mail
NIDA-CTN-0027 www

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