Kenneth Blum1,2,3,4,5,6,7, David Han8, Edward J Modestino9, Scott Saunders2, A Kennison Roy10, W Jacobs11, Darryl S Inaba12, David Baron3, Marlene Oscar-Berman13, Mary Hauser2, Rajendra D Badgaiyan14, David E Smith15, John Femino2, Mark S Gold16. 1. a Department of Psychiatry & McKnight Brain Institute , University of Florida College of Medicine , Gainesville , Florida , USA. 2. b Division of Addiction Services , Dominion Diagnostics, LLC , North Kingstown , Rhode Island , USA. 3. c Departments of Psychiatry & Behavioral Sciences , Keck School of Medicine of USC , Los Angeles , California , USA. 4. d Department of Psychology , Eötvös Loránd University, Institute of Psychology , Budapest , Hungary. 5. e Human Integrated Services Unit , University of Vermont Centre for Clinical & Translational Science, College of Medicine , Burlington , Vermont , USA. 6. f Division of Neuroscience Research & Addiction Therapy , Shores Treatment & Recovery Center , Port Saint Lucie , Florida , USA. 7. g Geneus Health , San Antonio , Texas , USA. 8. h Department of Management Science and Statistics , University of Texas at San Antonio , Texas , USA. 9. i Department of Psychology , Curry College , Milton , Massachusetts , USA. 10. j Behavioral Medical Corporation , Metairie , Louisiana , USA. 11. k Division of Addiction Medicine , Medical College of Georgia , Augusta , Georgia , USA. 12. l Division of Alcohol & Drug Studies , University of Utah , Salt Lake City , Utah , USA. 13. n Department of Psychiatry, Neurology, Anatomy & Neurobiology , Boston University School of Medicine, & VA Boston Healthcare System , Boston , Massachusetts , USA. 14. m Department of Psychiatry , Icahn School of Medicine , New York , New York , USA. 15. p Department of Pharmacology , University of San Francisco , San Francisco , California , USA. 16. o Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA.
Abstract
BACKGROUND: Buprenorphine and naloxone (bup/nal), a combination partial mu receptor agonist and low-dose delta mu antagonist, is presently recommended and used to treat opioid-use disorder. However, a literature review revealed a paucity of research involving data from urine drug tests that looked at compliance and abstinence in one sample. METHOD: Statistical analysis of data from the Comprehensive Analysis of Reported Drugs (CARD) was used to assess compliance and abstinence during treatment in a large cohort of bup/nal patients attending chemical-dependency programs from eastern USA in 2010 and 2011. RESULTS: Part 1: Bup/nal was present in 93.4% of first (n = 1,282; p <.0001) and 92.4% of last (n = 1,268; p <.0001) urine samples. Concomitantly, unreported illicit drugs were present in 47.7% (n = 655, p =.0261) of samples. Patients who were compliant to the bup/nal prescription were more likely than noncompliant patients to be abstinent during treatment (p =.0012; odds ratio = 1.69 with 95% confidence interval (1.210, 2.354). Part 2: An analysis of all samples collected in 2011 revealed a significant improvement in both compliance (p < 2.2 × 10-16) and abstinence (p < 2.2 × 10-16) during treatment. Conclusion/Importance: While significant use of illicit opioids during treatment with bup/nal is present, improvements in abstinence and high compliance during maintenance-assisted therapy programs may ameliorate fears of diversion in comprehensive programs. Expanded clinical datasets, the treatment modality, location, and year of sampling are important covariates, for further studies. The potential for long-term antireward effects from bup/nal use requires consideration in future investigations.
BACKGROUND:Buprenorphine and naloxone (bup/nal), a combination partial mu receptor agonist and low-dose delta mu antagonist, is presently recommended and used to treat opioid-use disorder. However, a literature review revealed a paucity of research involving data from urine drug tests that looked at compliance and abstinence in one sample. METHOD: Statistical analysis of data from the Comprehensive Analysis of Reported Drugs (CARD) was used to assess compliance and abstinence during treatment in a large cohort of bup/nal patients attending chemical-dependency programs from eastern USA in 2010 and 2011. RESULTS: Part 1: Bup/nal was present in 93.4% of first (n = 1,282; p <.0001) and 92.4% of last (n = 1,268; p <.0001) urine samples. Concomitantly, unreported illicit drugs were present in 47.7% (n = 655, p =.0261) of samples. Patients who were compliant to the bup/nal prescription were more likely than noncompliant patients to be abstinent during treatment (p =.0012; odds ratio = 1.69 with 95% confidence interval (1.210, 2.354). Part 2: An analysis of all samples collected in 2011 revealed a significant improvement in both compliance (p < 2.2 × 10-16) and abstinence (p < 2.2 × 10-16) during treatment. Conclusion/Importance: While significant use of illicit opioids during treatment with bup/nal is present, improvements in abstinence and high compliance during maintenance-assisted therapy programs may ameliorate fears of diversion in comprehensive programs. Expanded clinical datasets, the treatment modality, location, and year of sampling are important covariates, for further studies. The potential for long-term antireward effects from bup/nal use requires consideration in future investigations.
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Authors: Kenneth Blum; David Han; David Baron; Shan Kazmi; Igor Elman; Luis Llanos Gomez; Marjorie C Gondre-Lewis; Panyotis K Thanos; Eric R Braverman; Rajendra D Badgaiyan Journal: Curr Psychiatry Res Rev Date: 2022-06-21
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Authors: Kenneth Blum; Bruce Steinberg; Marjorie C Gondre-Lewis; David Baron; Edward J Modestino; Rajendra D Badgaiyan; B William Downs; Debasis Bagchi; Raymond Brewer; Thomas McLaughlin; Abdalla Bowirrat; Mark Gold Journal: Psychol Res Behav Manag Date: 2021-12-17