title: Buprenorphine/naloxone and methadone maintenance treatment outcomes for opioid analgesic, heroin, and combined users: findings from starting treatment with agonist replacement therapies (START).
abstract: OBJECTIVE
  The objective of this secondary analysis was to explore differences in baseline clinical characteristics and opioid replacement therapy treatment outcomes by type (heroin, opioid analgesic [OA], or combined [heroin and OA]) and route (injector or non-injector) of opioid use.
  
  
  METHODS
  A total of 1,269 participants (32.2% female) were randomized to receive one of two study medications (methadone or buprenorphine/naloxone [BUP]). Of these, 731 participants completed the 24-week active medication phase. Treatment outcomes were opioid use during the final 30 days of treatment (among treatment completers) and treatment attrition.
  
  
  RESULTS
  Non-opioid substance dependence diagnoses and injecting differentiated heroin and combined users from OA users. Non-opioid substance dependence diagnoses and greater heroin use differentiated injectors from non-injectors. Further, injectors were more likely to be using at end of treatment compared with non-injectors. OA users were more likely to complete treatment compared with heroin users and combined users. Non-injectors were more likely than injectors to complete treatment. There were no interactions between type of opioid used or injection status and treatment assignment (methadone or BUP) on either opioid use or treatment attrition.
  
  
  CONCLUSIONS
  Findings indicate that substance use severity differentiates heroin users from OA users and injectors from non-injectors. Irrespective of medication, heroin use and injecting are associated with treatment attrition and opioid misuse during treatment. These results have particular clinical interest, as there is no evidence of superiority of BUP over methadone for treating OA users versus heroin users.
authors.affiliation: The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA. PotterJS@uthscsa.edu
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Potter
authors.forename: Elise N
authors.initials: EN
authors.lastname: Marino
authors.forename: Maureen P
authors.initials: MP
authors.lastname: Hillhouse
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.forename: Katharina
authors.initials: K
authors.lastname: Wiest
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Canamar
authors.forename: Judith A
authors.initials: JA
authors.lastname: Martin
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ang
authors.forename: Rachael
authors.initials: R
authors.lastname: Baker
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
authors.forename: Walter
authors.initials: W
authors.lastname: Ling
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D000069479:Buprenorphine, Naloxone Drug Combination; D005260:Female; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D012720:Severity of Illness Index; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000534:rehabilitation; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone