title: Opioid withdrawal, craving, and use during and after outpatient buprenorphine stabilization and taper: a discrete survival and growth mixture model.
abstract: BACKGROUND
  Most patients relapse to opioids within one month of opioid agonist detoxification, making the antecedents and parallel processes of first use critical for investigation. Craving and withdrawal are often studied in relationship to opioid outcomes, and a novel analytic strategy applied to these two phenomena may indicate targeted intervention strategies.
  
  
  METHODS
  Specifically, this secondary data analysis of the Prescription Opioid Addiction Treatment Study used a discrete-time mixture analysis with time-to-first opioid use (survival) simultaneously predicted by craving and withdrawal growth trajectories. This analysis characterized heterogeneity among prescription opioid-dependent individuals (N=653) into latent classes (i.e., latent class analysis [LCA]) during and after buprenorphine/naloxone stabilization and taper.
  
  
  RESULTS
  A 4-latent class solution was selected for overall model fit and clinical parsimony. In order of shortest to longest time-to-first use, the 4 classes were characterized as 1) high craving and withdrawal, 2) intermediate craving and withdrawal, 3) high initial craving with low craving and withdrawal trajectories and 4) a low initial craving with low craving and withdrawal trajectories. Odds ratio calculations showed statistically significant differences in time-to-first use across classes.
  
  
  CONCLUSIONS
  Generally, participants with lower baseline levels and greater decreases in craving and withdrawal during stabilization combined with slower craving and withdrawal rebound during buprenorphine taper remained opioid-free longer. This exploratory work expanded on the importance of monitoring craving and withdrawal during buprenorphine induction, stabilization, and taper. Future research may allow individually tailored and timely interventions to be developed to extend time-to-first opioid use.
authors.affiliation: Department of Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin Street, JJL 324, Houston, TX 77030, USA. Electronic address: Thomas.f.northrup@uth.tmc.edu.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Northrup
authors.affiliation: Department of Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin Street, JJL 324, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, 1941 East Road, Houston, TX 77054, USA.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Stotts
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, 1941 East Road, Houston, TX 77054, USA; Department of Pediatrics, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 3.020, Houston, TX 77030, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Green
authors.affiliation: University of Texas Health Science Center at San Antonio, Department of Psychiatry, Mail Code 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA; McLean Hospital, Division of Alcohol and Drug Abuse & Harvard Medical School, Department of Psychiatry, 115 Mill Street, Belmont, MA 02478, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Potter
authors.affiliation: University of Texas Health Science Center at San Antonio, Department of Psychiatry, Mail Code 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
authors.forename: Elise N
authors.initials: EN
authors.lastname: Marino
authors.affiliation: University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA.
authors.forename: Robrina
authors.initials: R
authors.lastname: Walker
authors.affiliation: McLean Hospital, Division of Alcohol and Drug Abuse & Harvard Medical School, Department of Psychiatry, 115 Mill Street, Belmont, MA 02478, USA.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
authors.affiliation: University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA.
authors.forename: Madhukar
authors.initials: M
authors.lastname: Trivedi
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects; D002047:Buprenorphine / Q000627:therapeutic use*; D066249:Craving; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010045:Outpatients / Q000706:statistics & numerical data*; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine
keywords: Buprenorphine; Craving; Latent class; Opioid; Relapse; Withdrawal