Roger D Weiss1, Jennifer Sharpe Potter2, Margaret L Griffin3, Scott E Provost4, Garrett M Fitzmaurice5, Katherine A McDermott4, Emily N Srisarajivakul4, Dorian R Dodd4, Jessica A Dreifuss3, R Kathryn McHugh3, Kathleen M Carroll6. 1. McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: rweiss@mclean.harvard.edu. 2. McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. 3. McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. 4. McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA. 5. McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Biostatistics, Harvard School of Public Health, 677 Huntington Street, Boston, MA 02115, USA. 6. Department of Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
Abstract
BACKGROUND: Despite the growing prevalence of prescription opioid dependence, longitudinal studies have not examined long-term treatment response. The current study examined outcomes over 42 months in the Prescription Opioid Addiction Treatment Study (POATS). METHODS: POATS was a multi-site clinical trial lasting up to 9 months, examining different durations of buprenorphine-naloxone plus standard medical management for prescription opioid dependence, with participants randomized to receive or not receive additional opioid drug counseling. A subset of participants (N=375 of 653) enrolled in a follow-up study. Telephone interviews were administered approximately 18, 30, and 42 months after main-trial enrollment. Comparison of baseline characteristics by follow-up participation suggested few differences. RESULTS: At Month 42, much improvement was seen: 31.7% were abstinent from opioids and not on agonist therapy; 29.4% were receiving opioid agonist therapy, but met no symptom criteria for current opioid dependence; 7.5% were using illicit opioids while on agonist therapy; and the remaining 31.4% were using opioids without agonist therapy. Participants reporting a lifetime history of heroin use at baseline were more likely to meet DSM-IV criteria for opioid dependence at Month 42 (OR=4.56, 95% CI=1.29-16.04, p<.05). Engagement in agonist therapy was associated with a greater likelihood of illicit-opioid abstinence. Eight percent (n=27/338) used heroin for the first time during follow-up; 10.1% reported first-time injection heroin use. CONCLUSIONS: Long-term outcomes for those dependent on prescription opioids demonstrated clear improvement from baseline. However, a subset exhibited a worsening course, by initiating heroin use and/or injection opioid use.
RCT Entities:
BACKGROUND: Despite the growing prevalence of prescription opioid dependence, longitudinal studies have not examined long-term treatment response. The current study examined outcomes over 42 months in the Prescription Opioid Addiction Treatment Study (POATS). METHODS: POATS was a multi-site clinical trial lasting up to 9 months, examining different durations of buprenorphine-naloxone plus standard medical management for prescription opioid dependence, with participants randomized to receive or not receive additional opioid drug counseling. A subset of participants (N=375 of 653) enrolled in a follow-up study. Telephone interviews were administered approximately 18, 30, and 42 months after main-trial enrollment. Comparison of baseline characteristics by follow-up participation suggested few differences. RESULTS: At Month 42, much improvement was seen: 31.7% were abstinent from opioids and not on agonist therapy; 29.4% were receiving opioid agonist therapy, but met no symptom criteria for current opioid dependence; 7.5% were using illicit opioids while on agonist therapy; and the remaining 31.4% were using opioids without agonist therapy. Participants reporting a lifetime history of heroin use at baseline were more likely to meet DSM-IV criteria for opioid dependence at Month 42 (OR=4.56, 95% CI=1.29-16.04, p<.05). Engagement in agonist therapy was associated with a greater likelihood of illicit-opioid abstinence. Eight percent (n=27/338) used heroin for the first time during follow-up; 10.1% reported first-time injection heroin use. CONCLUSIONS: Long-term outcomes for those dependent on prescription opioids demonstrated clear improvement from baseline. However, a subset exhibited a worsening course, by initiating heroin use and/or injection opioid use.
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