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The Prescription Opioid Addiction Treatment Study: What Have We Learned.

Drug and Alcohol Dependence 2017;173:S48-S54. [doi: 10.1016/j.drugalcdep.2016.12.001]

Roger D. Weiss, MD (Harvard Medical School, McLean Hospital, NEC Node), Vinod Rao, MD (Harvard Medical School, Massachusetts General Hospital).

The multi-site Prescription Opioid Addiction Treatment Study (POATS), conducted by the NIDA Clinical Trials Network, was the largest clinical trial yet conducted with patients dependent on prescription opioids (N=653). In addition to main trial results, the study yielded numerous secondary analyses, and included a 3.5-year follow-up study, the first of its kind with this population. This paper summarizes the POATS design, main outcomes, predictors of outcome, subgroup analyses, the predictive power of early treatment response, and the long-term follow-up study.

POATS examined combinations of buprenorphine-naloxone of varying duration and counseling of varying intensity. The primary outcome analysis showed no overall benefit to adding drug counseling to buprenorphine-naloxone and weekly medical management. Only 7% of patients achieved a successful outcome (abstinence or near-abstinence from opioids) during a 4-week taper and 8-week follow-up; by comparison, 49% of patients achieved success while subsequently stabilized on buprenorphine-naloxone.

Long-term follow-up results were more encouraging, with higher abstinence rates than in the main trial. Patients receiving opioid agonist treatment at the time of follow-up were more likely to have better outcomes, though a sizeable number of patients succeeded without agonist treatment. Some patients initiated risky use patterns, including heroin use and drug injection. A limitation of the long-term follow-up study was the low follow-up rate.

Conclusions: POATS was the first large-scale study of the treatment of prescription opioid dependence; its findings can influence both treatment guidelines and future. In particular, the results of POATS suggest support for an individualized approach to behavioral interventions in the context of buprenorphine-naloxone treatment of prescription opioid use disorders. The fact that some patients benefited from counseling (heroin users who attended sessions regularly, for example) suggests that some patients would do well with just medical management and others should receive additional counseling. (Article (Peer-Reviewed), PDF, English, 2017)

Keywords: Buprenorphine/Naloxone | Heroin | Opioid dependence | Opioid detoxification | Pharmacological therapy | Prescription-type opiates | Suboxone | Taper schedules | Drug and Alcohol Dependence (journal)

Document No: 1264, PMID: 28363320.

Submitted by the CTN Dissemination Librarians (4/3/2017).

Rao, Vinod mail
Weiss, Roger D. mail
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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.
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