Thomas F Northrup1, Angela L Stotts2, Charles Green3, Jennifer S Potter4, Elise N Marino5, Robrina Walker6, Roger D Weiss7, Madhukar Trivedi6. 1. Department of Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin Street, JJL 324, Houston, TX 77030, USA. Electronic address: Thomas.f.northrup@uth.tmc.edu. 2. Department of Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin Street, JJL 324, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, 1941 East Road, Houston, TX 77054, USA. 3. Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, 1941 East Road, Houston, TX 77054, USA; Department of Pediatrics, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 3.020, Houston, TX 77030, USA. 4. University of Texas Health Science Center at San Antonio, Department of Psychiatry, Mail Code 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA; McLean Hospital, Division of Alcohol and Drug Abuse & Harvard Medical School, Department of Psychiatry, 115 Mill Street, Belmont, MA 02478, USA. 5. University of Texas Health Science Center at San Antonio, Department of Psychiatry, Mail Code 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA. 6. University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA. 7. McLean Hospital, Division of Alcohol and Drug Abuse & Harvard Medical School, Department of Psychiatry, 115 Mill Street, Belmont, MA 02478, USA.
Abstract
INTRODUCTION: Most patients relapse to opioids within one month of opioid agonist detoxification, making the antecedents and parallel processes of first use critical for investigation. Craving and withdrawal are often studied in relationship to opioid outcomes, and a novel analytic strategy applied to these two phenomena may indicate targeted intervention strategies. METHODS: Specifically, this secondary data analysis of the Prescription Opioid Addiction Treatment Study used a discrete-time mixture analysis with time-to-first opioid use (survival) simultaneously predicted by craving and withdrawal growth trajectories. This analysis characterized heterogeneity among prescription opioid-dependent individuals (N=653) into latent classes (i.e., latent class analysis [LCA]) during and after buprenorphine/naloxone stabilization and taper. RESULTS: A 4-latent class solution was selected for overall model fit and clinical parsimony. In order of shortest to longest time-to-first use, the 4 classes were characterized as 1) high craving and withdrawal, 2) intermediate craving and withdrawal, 3) high initial craving with low craving and withdrawal trajectories and 4) a low initial craving with low craving and withdrawal trajectories. Odds ratio calculations showed statistically significant differences in time-to-first use across classes. CONCLUSIONS: Generally, participants with lower baseline levels and greater decreases in craving and withdrawal during stabilization combined with slower craving and withdrawal rebound during buprenorphine taper remained opioid-free longer. This exploratory work expanded on the importance of monitoring craving and withdrawal during buprenorphine induction, stabilization, and taper. Future research may allow individually tailored and timely interventions to be developed to extend time-to-first opioid use.
RCT Entities:
INTRODUCTION: Most patients relapse to opioids within one month of opioid agonist detoxification, making the antecedents and parallel processes of first use critical for investigation. Craving and withdrawal are often studied in relationship to opioid outcomes, and a novel analytic strategy applied to these two phenomena may indicate targeted intervention strategies. METHODS: Specifically, this secondary data analysis of the Prescription Opioid Addiction Treatment Study used a discrete-time mixture analysis with time-to-first opioid use (survival) simultaneously predicted by craving and withdrawal growth trajectories. This analysis characterized heterogeneity among prescription opioid-dependent individuals (N=653) into latent classes (i.e., latent class analysis [LCA]) during and after buprenorphine/naloxone stabilization and taper. RESULTS: A 4-latent class solution was selected for overall model fit and clinical parsimony. In order of shortest to longest time-to-first use, the 4 classes were characterized as 1) high craving and withdrawal, 2) intermediate craving and withdrawal, 3) high initial craving with low craving and withdrawal trajectories and 4) a low initial craving with low craving and withdrawal trajectories. Odds ratio calculations showed statistically significant differences in time-to-first use across classes. CONCLUSIONS: Generally, participants with lower baseline levels and greater decreases in craving and withdrawal during stabilization combined with slower craving and withdrawal rebound during buprenorphine taper remained opioid-free longer. This exploratory work expanded on the importance of monitoring craving and withdrawal during buprenorphine induction, stabilization, and taper. Future research may allow individually tailored and timely interventions to be developed to extend time-to-first opioid use.
Authors: Susan D Whitley; Nancy L Sohler; Hillary V Kunins; Angela Giovanniello; Xuan Li; Galit Sacajiu; Chinazo O Cunningham Journal: J Subst Abuse Treat Date: 2010-07
Authors: Evgeny Krupitsky; Edward V Nunes; Walter Ling; Ari Illeperuma; David R Gastfriend; Bernard L Silverman Journal: Lancet Date: 2011-04-30 Impact factor: 79.321
Authors: Roger D Weiss; Margaret L Griffin; Carissa Mazurick; Benjamin Berkman; David R Gastfriend; Arlene Frank; Jacques P Barber; Jack Blaine; Ihsan Salloum; Karla Moras Journal: Am J Psychiatry Date: 2003-07 Impact factor: 18.112
Authors: D Andrew Tompkins; George E Bigelow; Joseph A Harrison; Rolley E Johnson; Paul J Fudala; Eric C Strain Journal: Drug Alcohol Depend Date: 2009-08-03 Impact factor: 4.492
Authors: Paolo Mannelli; Ashwin A Patkar; Kathi Peindl; David A Gorelick; Li-Tzy Wu; Edward Gottheil Journal: Addict Biol Date: 2008-08-19 Impact factor: 4.280
Authors: Maria Sullivan; Adam Bisaga; Martina Pavlicova; C Jean Choi; Kaitlyn Mishlen; Kenneth M Carpenter; Frances R Levin; Elias Dakwar; John J Mariani; Edward V Nunes Journal: Am J Psychiatry Date: 2017-01-10 Impact factor: 18.112
Authors: Kelly E Dunn; Andrew S Huhn; Cecilia L Bergeria; Cassandra D Gipson; Elise M Weerts Journal: J Pharmacol Exp Ther Date: 2019-08-07 Impact factor: 4.030
Authors: Judith I Tsui; Marlene C Lira; Debbie M Cheng; Michael R Winter; Daniel P Alford; Jane M Liebschutz; Robert R Edwards; Jeffrey H Samet Journal: Drug Alcohol Depend Date: 2016-06-27 Impact factor: 4.492
Authors: Kelly E Dunn; Elise M Weerts; Andrew S Huhn; Jennifer R Schroeder; David Andrew Tompkins; George E Bigelow; Eric C Strain Journal: Addict Biol Date: 2018-10-08 Impact factor: 4.280