title: The multi-site prescription opioid addiction treatment study: 18-month outcomes.
abstract: Despite the high prevalence of prescription opioid dependence in the U.S., little is known about the course of this disorder and long-term response to treatment. We therefore examined 18-month post-randomization outcomes of participants in the Prescription Opioid Addiction Treatment Study, a multi-site, randomized controlled trial examining varying durations of buprenorphine-naloxone treatment and different intensities of counseling for prescription opioid dependence. Thus the current follow-up study provides a unique contribution to the field by reporting longer-term outcomes of a well-characterized population of treatment-seeking prescription opioid dependent patients. Participants from the treatment trial (N=252/653) completed an 18-month follow-up telephone assessment. Multivariable analyses examined associations between participant characteristics and key indicators of month-18 status: opioid abstinence, DSM-IV opioid dependence, and opioid agonist treatment. Overall, participants showed improvement from baseline to month 18: 49.6% were abstinent in the previous 30 days, with only 16.3% opioid-dependent. Some participants, however, had initiated past-year heroin use (n=9) or opioid injection (n=17). Most participants (65.9%) engaged in substance use disorder treatment during the past year, most commonly opioid agonist therapy (48.8%). Of particular interest in this population, multivariable analysis showed that greater pain severity at baseline was associated with opioid dependence at 18 months. In conclusion, although opioid use outcomes during the treatment trial were poor immediately following a buprenorphine-naloxone taper compared to those during 12 weeks of buprenorphine-naloxone stabilization, opioid use outcomes at 18-month follow-up showed substantial improvement over baseline and were comparable to the rate of successful outcomes during buprenorphine-naloxone stabilization in the treatment trial.
authors.affiliation: University of Texas Health Science Center at San Antonio, 7526 Louis Pasteur Drive, San Antonio, TX 78229, USA; McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
authors.forename: Jennifer Sharpe
authors.initials: JS
authors.lastname: Potter
authors.affiliation: McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Dreifuss
authors.affiliation: University of Texas Health Science Center at San Antonio, 7526 Louis Pasteur Drive, San Antonio, TX 78229, USA.
authors.forename: Elise N
authors.initials: EN
authors.lastname: Marino
authors.affiliation: McLean Hospital, 115 Mill St, Belmont, MA 02478, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Provost
authors.affiliation: McLean Hospital, 115 Mill St, Belmont, MA 02478, USA.
authors.forename: Dorian R
authors.initials: DR
authors.lastname: Dodd
authors.affiliation: McLean Hospital, 115 Mill St, Belmont, MA 02478, USA.
authors.forename: Lindsay S
authors.initials: LS
authors.lastname: Rice
authors.affiliation: McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Fitzmaurice
authors.affiliation: McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Griffin
authors.affiliation: McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. Electronic address: rweiss@mclean.harvard.edu.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000494:pharmacology; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage / Q000494:pharmacology; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D063487:Prescription Drug Misuse / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine
keywords: Buprenorphine; Clinical trial; Follow-up; Prescription opioids; Substance use disorder; Treatment