Marc Fishman1,2, Kevin Wenzel1, Jennifer Scodes3, Martina Pavlicova4, Aimee N C Campbell5, John Rotrosen6, Edward Nunes5. 1. Mountain Manor Treatment Center/Maryland Treatment Centers, Baltimore, Maryland. 2. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Division of Mental Health Data Science, New York State Psychiatric Institute, New York, New York. 4. Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York. 5. Department of Psychiatry, Columbia University Irving Medical Center, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York. 6. Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York.
Abstract
BACKGROUND AND OBJECTIVES: Opioid use disorder (OUD) treatment outcomes are poorer for young adults than older adults. Developmental differences are broadly implicated, but particular vulnerability factor interactions are poorly understood. This study sought to identify moderators of OUD relapse between age groups. METHODS: This secondary analysis compared young adults (18-25) to older adults (26+) from a comparative effectiveness trial ("XBOT") that randomized (N = 570) participants to extended-release naltrexone or sublingual buprenorphine-naloxone. We explored the relationship between 25 prespecified patient baseline characteristics and relapse to regular opioid use by age group and treatment condition, using logistic regression. RESULTS: Young adults (n = 111) had higher rates of 24-week relapse than older adults (n = 459) (70.3% vs 58.8%) and differed on a number of specific characteristics, including more smokers, more intravenous opioid use, and more cannabis use. No significant moderators predicted relapse, in either three-way or two-way interactions. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: No baseline factors were identified as moderating the relationship between age group and opioid relapse, nor any interactions between baseline characteristics, age group, and treatment condition to predict opioid relapse. Poorer treatment outcomes for young adults are likely associated with multiple developmental vulnerabilities rather than any single predominant factor. Although not reaching significance, several characteristics (using heroin, smoking tobacco, high levels of depression/anxiety, or treatment because of family/friends) showed higher odds ratio point estimates for relapse in young adults than older adults. This is the first study to explore moderators of worse OUD treatment outcomes in young adults, highlighting the need to identify predictor variables that could inform treatment enhancements. (Am J Addict 2021;00:1-12).
BACKGROUND AND OBJECTIVES: Opioid use disorder (OUD) treatment outcomes are poorer for young adults than older adults. Developmental differences are broadly implicated, but particular vulnerability factor interactions are poorly understood. This study sought to identify moderators of OUD relapse between age groups. METHODS: This secondary analysis compared young adults (18-25) to older adults (26+) from a comparative effectiveness trial ("XBOT") that randomized (N = 570) participants to extended-release naltrexone or sublingual buprenorphine-naloxone. We explored the relationship between 25 prespecified patient baseline characteristics and relapse to regular opioid use by age group and treatment condition, using logistic regression. RESULTS: Young adults (n = 111) had higher rates of 24-week relapse than older adults (n = 459) (70.3% vs 58.8%) and differed on a number of specific characteristics, including more smokers, more intravenous opioid use, and more cannabis use. No significant moderators predicted relapse, in either three-way or two-way interactions. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: No baseline factors were identified as moderating the relationship between age group and opioid relapse, nor any interactions between baseline characteristics, age group, and treatment condition to predict opioid relapse. Poorer treatment outcomes for young adults are likely associated with multiple developmental vulnerabilities rather than any single predominant factor. Although not reaching significance, several characteristics (using heroin, smoking tobacco, high levels of depression/anxiety, or treatment because of family/friends) showed higher odds ratio point estimates for relapse in young adults than older adults. This is the first study to explore moderators of worse OUD treatment outcomes in young adults, highlighting the need to identify predictor variables that could inform treatment enhancements. (Am J Addict 2021;00:1-12).
Authors: Efrat Aharonovich; Deborah S Hasin; Adam C Brooks; Xinhua Liu; Adam Bisaga; Edward V Nunes Journal: Drug Alcohol Depend Date: 2005-09-19 Impact factor: 4.492
Authors: Mary M Sweeney; Olga Rass; Cara DiClemente; Rebecca L Schacht; Hoa T Vo; Marc J Fishman; Jeannie-Marie S Leoutsakos; Miriam Z Mintzer; Matthew W Johnson Journal: J Child Adolesc Subst Abuse Date: 2018-04-10
Authors: Edward V Nunes; Jennifer M Scodes; Martina Pavlicova; Joshua D Lee; Patricia Novo; Aimee N C Campbell; John Rotrosen Journal: Am J Psychiatry Date: 2021-06-25 Impact factor: 18.112
Authors: Joshua D Lee; Edward V Nunes; Patricia Novo; Ken Bachrach; Genie L Bailey; Snehal Bhatt; Sarah Farkas; Marc Fishman; Phoebe Gauthier; Candace C Hodgkins; Jacquie King; Robert Lindblad; David Liu; Abigail G Matthews; Jeanine May; K Michelle Peavy; Stephen Ross; Dagmar Salazar; Paul Schkolnik; Dikla Shmueli-Blumberg; Don Stablein; Geetha Subramaniam; John Rotrosen Journal: Lancet Date: 2017-11-14 Impact factor: 79.321
Authors: Laura B Monico; Ariel Ludwig; Elizabeth Lertch; Ross Dionne; Marc Fishman; Robert P Schwartz; Shannon Gwin Mitchell Journal: Addiction Date: 2020-08-31 Impact factor: 6.526