Short term health-related quality of life improvement during opioid agonist treatment.
BACKGROUND
Opioid dependence is associated with high levels of morbidity, yet sparse data exists regarding the health-related quality of life (HRQoL) of individuals with opioid dependence, particularly following treatment initiation. To inform cost-effectiveness analyses of treatment modalities, this study investigates short-term changes in HRQoL following enrollment into opioid agonist treatment (OAT), across treatment modalities and patient subgroups.


METHODS
Data was analyzed from the Starting Treatment with Agonist Replacement Therapies (START) and Prescription Opioid Addiction Treatment Studies (POATS) randomized controlled trials. Participants included individuals dependent on prescription opioids (POs) or heroin, receiving limited-term or time-unlimited treatment. PO- or heroin-users in START received buprenorphine/naloxone (BUP/NX) or methadone (MET) over 24 weeks. PO-users in POATS received psychosocial care and short-term (4-week) taper with BUP/NX, with non-responders offered subsequent extended (12-week) stabilization and taper. HRQoL was assessed using the short-form SF-6D while in and out of OAT, with distinction between MMT and BUP/NX in START. Linear mixed effects regression models were fitted to determine the independent effects of OAT on HRQoL and characterize HRQoL trajectories.


RESULTS
Treatment had a similar immediate and modest positive association with HRQoL in each patient subgroup. The association of OAT on HRQoL was statistically significant in each model, with effect sizes between 0.039 (heroin-users receiving BUP/NX) and 0.071 (PO-users receiving MET). After initial improvement, HRQoL decreased slightly, or increased at a diminished rate.


CONCLUSIONS
OAT, whether delivered in time-limited or unlimited form, using BUP/NX or MET, is associated with modest immediate HRQoL improvements, with diminishing benefits thereafter.
BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. Electronic address: bnosyk@cfenet.ubc.ca.
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B
Nosyk
Department of Economics, University of North Carolina, Greensboro, NC, United States; Research Triangle International, Durham, NC, United States.
J W
JW
Bray
Harvard School of Public Health, Boston, MA, United States.
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E
Wittenberg
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States.
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B
Aden
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States.
A A
AA
Eggman
Harvard Medical School, Boston, MA, United States; McLean Hospital, Belmont, MA, United States.
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RD
Weiss
Departments of Psychiatry and Anesthesiology (Pain Medicine), Faculty of Medicine, University of Texas Health Science Center, San Antonio, TX, United States.
J
J
Potter
UCLA Integrated Substance Abuse Programs, Los Angeles, CA, United States.
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A
Ang
UCLA Integrated Substance Abuse Programs, Los Angeles, CA, United States.
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YI
Hser
UCLA Integrated Substance Abuse Programs, Los Angeles, CA, United States.
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W
Ling
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States.
B R
BR
Schackman
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000069479:Buprenorphine, Naloxone Drug Combination / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006304:Health Status; D003932:Heroin / Q000009:adverse effects; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic
D000701:Analgesics, Opioid; D000069479:Buprenorphine, Naloxone Drug Combination; D003932:Heroin; D008691:Methadone
Buprenorphine/naloxone; HRQoL; Health related quality of life; Health utility; Methadone; Opioid agonist treatment; Opioid use disorder; Suboxone