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Distinctive Trajectories of Opioid Use Over an Extended Follow-Up of Patients in a Multisite Trial on Buprenorphine + Naloxone and Methadone.

Journal of Addiction Medicine 2017;11(1):63-69. [doi: 10.1097/ADM.0000000000000274]

Yih-Ing Hser, PhD (University of California, Los Angeles, PR Node), David Huang, DrPh (University of California, Los Angeles, PR Node), Andrew J. Saxon, MD (VA Puget Sound Health Care System, PNW Node), George Woody, MD (University of Pennsylvania, MA Node), Andrew L. Moskowitz, MA (University of California, Los Angeles, PR Node), Abigail G. Matthews, PhD (Data and Statistics Center, Emmes), Walter Ling, MD (University of California, Los Angeles, PR Node).

Uncovering heterogeneities in longitudinal patterns (trajectories) of opioid use among individuals with opioid use disorder can increase our understanding of disease progression and treatment responses to improve care. The present study aims to identify distinctive opioid use trajectories and factors associated with those patterns among participants randomized to treatment with methadone (MET) or buprenorphine + naloxone (BUP). Growth mixture modeling was applied to identify distinctive opioid use trajectories among 795 opioid users after their enrollment in CTN-0027 (CTN START trial), a multisite trial during 2006 to 2009, with follow-up interviews conducted during 2011 to 2014 (CTN-0050 START Follow-up trial).

Four distinctive trajectories were identified based on opioid use over the follow-up period: low use (42%), high use (22.3%), increasing use (17.1%), and decreasing use (18.6%). Greater odds of being in the high use group (relative to low use) was associated with Hispanics (relative to African American, odds ratio [OR] 3.21), injection drug use (OR 2.12), higher mental health functioning at baseline (OR 1.23), location on the West Coast (vs. East Coast, OR 2.15), and randomization to BUP (relative to MET, OR 1.53). High use and increasing use groups had greater severity in problems related to drug, employment, legal, and social/family relationships, and worsened mental health functioning at follow-up. Participation in treatment significantly accounted for both within and between-group differences in opioid use.

A very promising finding is that the largest group (more than 40% of the sample) demonstrated a consistently low level of use after entering the medication trial. In contrast, approximately 17% of the participants gradually increased their opioid use after they initially reduced use, and another 19% did not respond well initially, but gradually decreased use over time.

Conclusions: The study findings underscore the importance of keeping opioid-dependent individuals in treatment and making treatment more widely available and accessible. Identifying factors that may account for distinctive opioid use trajectory patterns can further information policy decisions and clinic practice in targeting those at greatest need for opioid treatment. (Article (Peer-Reviewed), PDF, English, 2017)

Keywords: Buprenorphine/Naloxone | Heroin | Methadone maintenance | Opioid use trajectory | Prescription-type opiates | Suboxone | Journal of Addiction Medicine (journal)

Document No: 1254, PMID: 27898496, PMCID: PMC5291756 (available 1/1/2018).

Submitted by the CTN Dissemination Librarians (2/8/2017).

Hser, Yih-Ing mail
Huang, David
Matthews, Abigail G. mail
Moskowitz, Andrew L.
Ling, Walter
Saxon, Andrew J. mail
Woody, George mail
NIDA-CTN-0027 www
NIDA-CTN-0050 www
Pacific Region www
Delaware Valley www
New England Consortium www
Pacific Northwest www
Western States www

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Supported by a grant from the National Institute on Drug Abuse to the University of Washington Alcohol and Drug Abuse Institute.
The materials on this site have neither been created nor reviewed by NIDA.
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