Baseline characteristics and treatment outcomes in prescription opioid dependent patients with and without co-occurring psychiatric disorder.
BACKGROUND
Given the growing prevalence of prescription opioid dependence and the considerable rates of additional psychopathology in drug dependence, we examined the association between the presence of a co-occurring Axis I psychiatric disorder and sociodemographic and clinical characteristics in this secondary analysis of patients entering a treatment study for dependence on prescription opioids. Treatment outcomes were also compared.


METHODS
Patients dependent on prescription opioids participated in a multi-site, two-phase, randomized, controlled trial to assess different lengths of buprenorphine-naloxone pharmacotherapy and different intensities of counseling (Clinicaltrials.gov identifier: NCT00316277). Among the 653 participants entering the first phase of the trial, 360 entered the second phase, receiving 12 weeks of buprenorphine-naloxone treatment; they are reported here. Half of those participants (180/360) had a current co-occurring psychiatric disorder in addition to substance dependence.


RESULTS
Sociodemographic characteristics were similar overall between those with and without a co-occurring psychiatric disorder, but women were 1.6 times more likely than men to have a co-occurring disorder. On several clinical indicators at baseline, participants with a co-occurring disorder had greater impairment. However, they had better opioid use outcomes at the conclusion of 12 weeks of buprenorphine-naloxone stabilization than did participants without a co-occurring disorder.


CONCLUSIONS
Prescription opioid-dependent patients with a co-occurring psychiatric disorder had a better response to buprenorphine-naloxone treatment despite demonstrating greater impairment at baseline. Additional research is needed to determine the mechanism of this finding and to adapt treatments to address this population.
Division of Alcohol and Drug Abuse, McLean Hospital , Belmont, MA , USA .
Margaret L
ML
Griffin
Dorian R
DR
Dodd
Jennifer S
JS
Potter
Lindsay S
LS
Rice
William
W
Dickinson
Steven
S
Sparenborg
Roger D
RD
Weiss
D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D017831:Diagnosis, Dual (Psychiatry); D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*; D055553:Prescription Drugs; D016896:Treatment Outcome; D055815:Young Adult
D009292:Narcotic Antagonists; D055553:Prescription Drugs; D009270:Naloxone; D002047:Buprenorphine