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Correlates of Opioid Abstinence in a 42-Month Posttreatment Naturalistic Follow-Up Study of Prescription Opioid Dependence
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Overview
Which treatments are strongly associated with opioid abstinence over time among patients with prescription opioid dependence? Mutual-help group attendance?
Abstract
Objective: The natural course of prescription opioid use disorder has not been examined in longitudinal studies. The current study examined correlates of opioid abstinence over time after completion of a treatment trial for prescription opioid dependence.
Methods: The multisite Prescription Opioid Addiction Treatment Study examined different durations of buprenorphine-naloxone treatment and different intensities of counseling to treat prescription opioid dependence, as assessed by DSM-IV; following the clinical trial, a longitudinal study was conducted from March 2009–January 2013. At 18, 30, and 42 months after treatment entry, telephone interviews were conducted (N = 375). In this exploratory, naturalistic study, logistic regression analyses examined the association between treatment modality (including formal treatment and mutual help) and opioid abstinence rates at the follow-up assessments.
Results: At the 3 follow-up assessments, approximately half of the participants reported engaging in current substance use disorder treatment (47%–50%). The most common treatments were buprenorphine maintenance (27%–35%) and mutual-help group attendance (27%–30%), followed by outpatient counseling (18%–23%) and methadone maintenance (4%). In adjusted analyses, current opioid agonist treatment showed the strongest association with current opioid abstinence (odds ratios [ORs] = 5.4, 4.6, and 2.8 at the 3 assessments), followed by current mutual-help attendance (ORs = 2.2, 2.7, and 1.9); current outpatient counseling was not significantly associated with abstinence in the adjusted models.
Conclusions: While opioid agonist treatment was most strongly associated with opioid abstinence among patients with prescription opioid dependence over time, mutual-help group attendance was independently associated with opioid abstinence. Clinicians should consider recommending both of these interventions to patients with opioid use disorder.
To cite: Weiss RD, Griffin ML, Marcovitz DE, et al. Correlates of opioid abstinence in a 42-month posttreatment naturalistic follow-up study of prescription opioid dependence. J Clin Psychiatry. 2019;80(2):18m12292.
To share: https://doi.org/10.4088/JCP.18m12292
Read the whole article at psychiatrist.com here:
Correlates of Opioid Abstinence in a 42-Month Posttreatment Naturalistic Follow-Up Study of Prescription Opioid Dependence
© Copyright 2019 Physicians Postgraduate Press, Inc.
Target Audience
Psychiatrists
Learning Objectives
- Consider recommending both opioid agonist treatment and mutual-help group attendance to improve opioid abstinence in patients with opioid use disorder
CME Background
Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.
CME Objective
After studying this article, you should be able to:
- Consider recommending both opioid agonist treatment and mutual-help group attendance to improve opioid abstinence in patients with opioid use disorder
Statement of Need and Purpose
Clinicians need education about evidence on correlates of opioid abstinence over time after completion of a treatment trial for prescription opioid dependence, including buprenorphine maintenance, mutual-help group attendance, outpatient counseling, and methadone maintenance.
Release, Expiration, and Review Dates
This educational activity was published in March 2019 and is eligible for AMA PRA Category 1 Credit™ through April 30, 2021. The latest review of this material was February 2019.
Disclosure of Off-Label Usage
The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration–approved labeling has been presented in this article.
Funding/Support
This work was supported by grants from National Institute on Drug Abuse (NIDA) as part of the Cooperative Agreement on the Clinical Trials Network (Grant U10DA015831) and NIDA grants K24DA022288 and K23DA035297.
Role of the sponsor
NIDA had no further role in study design; in the collection, analysis, and interpretation of data; or in the writing of the report. The NIDA Clinical Trials Network Publication Committee reviewed a draft of this manuscript and approved it for submission for publication.
Previous presentation
An earlier version of this paper was presented at the 79th Annual Meeting of the College on Problems of Drug Dependence; June 17–22, 2017; Montreal, Quebec, Canada.
Faculty Affiliation
Roger D. Weiss, MD*
Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
Margaret L. Griffin, PhD
Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
David E. Marcovitz, MD
Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
Blake T. Hilton, PsyD
Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
Garrett M. Fitzmaurice, ScD
Department of Psychiatry, Harvard Medical School, Boston; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston; and Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts
R. Kathryn McHugh, PhD
Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
Kathleen M. Carroll, PhD
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
*Corresponding author: Roger D. Weiss, MD, McLean Hospital, 115 Mill St, Belmont, MA 02478 ([email protected]).
Financial Disclosure
All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.
Dr Weiss has been a consultant for US World Meds, Braeburn Pharmaceuticals, Daiichi Sankyo, and GW Pharmaceuticals. Drs Griffin, Marcovitz, Hilton, Fitzmaurice, McHugh, and Carroll have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation