Predictors of outcome for short-term medically supervised opioid withdrawal during a randomized, multicenter trial of buprenorphine-naloxone and clonidine in the NIDA clinical trials network drug and alcohol dependence.
Few studies in community settings have evaluated predictors, mediators, and moderators of treatment success for medically supervised opioid withdrawal treatment. This report presents new findings about these factors from a study of 344 opioid-dependent men and women prospectively randomized to either buprenorphine-naloxone or clonidine in an open-label 13-day medically supervised withdrawal study. Subjects were either inpatient or outpatient in community treatment settings; however not randomized by treatment setting. Medication type (buprenorphine-naloxone versus clonidine) was the single best predictor of treatment retention and treatment success, regardless of treatment setting. Compared to the outpatient setting, the inpatient setting was associated with higher abstinence rates but similar retention rates when adjusting for medication type. Early opioid withdrawal severity mediated the relationship between medication type and treatment outcome with buprenorphine-naloxone being superior to clonidine at relieving early withdrawal symptoms. Inpatient subjects on clonidine with lower withdrawal scores at baseline did better than those with higher withdrawal scores; inpatient subjects receiving buprenorphine-naloxone did better with higher withdrawal scores at baseline than those with lower withdrawal scores. No relationship was found between treatment outcome and age, gender, race, education, employment, marital status, legal problems, baseline depression, or length/severity of drug use. Tobacco use was associated with worse opioid treatment outcomes. Severe baseline anxiety symptoms doubled treatment success. Medication type (buprenorphine-naloxone) was the most important predictor of positive outcome; however the paper also considers other clinical and policy implications of other results, including that inpatient setting predicted better outcomes and moderated medication outcomes.
Ziedonis
Douglas M
DM
National Institute on Drug Abuse Clinical Trials Network, University of Massachusetts Medical School, New England Node, Worcester, MA 01581, USA. ZiedoniD@ummhc.org
Amass
Leslie
L
Steinberg
Marc
M
Woody
George
G
Krejci
Jonathan
J
Annon
Jeffrey J
JJ
Cohen
Allan J
AJ
Waite-O'Brien
Nancy
N
Stine
Susan M
SM
McCarty
Dennis
D
Reid
Malcolm S
MS
Brown
Lawrence S
LS
Maslansky
Robert
R
Winhusen
Theresa
T
Babcock
Dean
D
Brigham
Greg
G
Muir
Joan
J
Orr
Deborah
D
Buchan
Betty J
BJ
Horton
Terry
T
Ling
Walter
W
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D002047:Buprenorphine / Q000627:therapeutic use*; D003000:Clonidine / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D003863:Depression / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D054563:National Institute on Alcohol Abuse and Alcoholism (U.S.); D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011379:Prognosis; D012907:Smoking / Q000523:psychology; D012959:Socioeconomic Factors; D015813:Substance Abuse Detection; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
D000316:Adrenergic alpha-Agonists; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine; D003000:Clonidine