title: Using behavioral economics to predict opioid use during prescription opioid dependence treatment.
abstract: BACKGROUND
  Research grounded in behavioral economics has previously linked addictive behavior to disrupted decision-making and reward-processing, but these principles have not been examined in prescription opioid addiction, which is currently a major public health problem. This study examined whether pre-treatment drug reinforcement value predicted opioid use during outpatient treatment of prescription opioid addiction.
  
  
  METHODS
  Secondary analyses examined participants with prescription opioid dependence who received 12 weeks of buprenorphine-naloxone and counseling in a multi-site clinical trial (N=353). Baseline measures assessed opioid source and indices of drug reinforcement value, including the total amount and proportion of income spent on drugs. Weekly urine drug screens measured opioid use.
  
  
  RESULTS
  Obtaining opioids from doctors was associated with lower pre-treatment drug spending, while obtaining opioids from dealers/patients was associated with greater spending. Controlling for demographics, opioid use history, and opioid source frequency, patients who spent a greater total amount (OR=1.30, p<.001) and a greater proportion of their income on drugs (OR=1.31, p<.001) were more likely to use opioids during treatment.
  
  
  CONCLUSIONS
  Individual differences in drug reinforcement value, as indicated by pre-treatment allocation of economic resources to drugs, reflects propensity for continued opioid use during treatment among individuals with prescription opioid addiction. Future studies should examine disrupted decision-making and reward-processing in prescription opioid users more directly and test whether reinforcer pathology can be remediated in this population.
authors.affiliation: Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024, United States. Electronic address: mworley@mednet.ucla.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Worley
authors.affiliation: Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024, United States.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Shoptaw
authors.affiliation: Addiction Recovery Research Center (ARRC), Virginia Tech Carillion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States.
authors.forename: Warren K
authors.initials: WK
authors.lastname: Bickel
authors.affiliation: Integrated Substance Abuse Program, University of California, Los Angeles, 1640 S. Sepulveda, Ste. 120, Los Angeles, CA 90024, United States.
authors.forename: Walter
authors.initials: W
authors.lastname: Ling
mesh_terms: D000328:Adult; D000368:Aged; D002047:Buprenorphine / Q000191:economics / Q000627:therapeutic use; D000069479:Buprenorphine, Naloxone Drug Combination / Q000191:economics / Q000627:therapeutic use; D060909:Economics, Behavioral / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000191:economics / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000191:economics / Q000523:psychology* / Q000639:trends*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000191:economics / Q000523:psychology*; D011237:Predictive Value of Tests; D063487:Prescription Drug Misuse / Q000191:economics / Q000523:psychology* / Q000639:trends*; D016896:Treatment Outcome
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine
keywords: Behavioral economics; Buprenorphine–naloxone; Prescription opioids; Treatment outcome