Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence A 2-Phase Randomized Controlled Trial
Roger D. Weiss,Jennifer Sharpe Potter,David A. Fiellin,David A. Fiellin,Marilyn Byrne,Marilyn Byrne,Hilary S. Connery,Hilary S. Connery,William Dickinson,John G. Gardin,John G. Gardin,Margaret L. Griffin,Margaret L. Griffin,Marc N. Gourevitch,Deborah L. Haller,Deborah L. Haller,Albert Hasson,Zhen Huang,Petra Jacobs,Andrzej S. Kosinski,Robert Lindblad,Elinore F. McCance-Katz,Elinore F. McCance-Katz,Scott E. Provost,Scott E. Provost,Jeffrey Selzer,Jeffrey Selzer,Eugene Somoza,Eugene Somoza,Susan C. Sonne,Walter Ling +30 more
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TLDR
Prescription opioid-dependent patients are most likely to reduce opioid use during buprenorphine-naloxone treatment; if tapered off bupreliminary treatment, even after 12 weeks of treatment, the likelihood of an unsuccessful outcome is high, even in patients receiving counseling in addition to SMM.Abstract:
Context No randomized trials have examined treatments for prescription opioid dependence, despite its increasing prevalence. Objective To evaluate the efficacy of brief and extended buprenorphine hydrochloride-naloxone hydrochloride treatment, with different counseling intensities, for patients dependent on prescription opioids. Design Multisite, randomized clinical trial using a 2-phase adaptive treatment research design. Brief treatment (phase 1) included 2-week buprenorphine-naloxone stabilization, 2-week taper, and 8-week postmedication follow-up. Patients with successful opioid use outcomes exited the study; unsuccessful patients entered phase 2: extended (12-week) buprenorphine-naloxone treatment, 4-week taper, and 8-week postmedication follow-up. Setting Ten US sites. Patients A total of 653 treatment-seeking outpatients dependent on prescription opioids. Interventions In both phases, patients were randomized to standard medical management (SMM) or SMM plus opioid dependence counseling; all received buprenorphine-naloxone. Main outcome measures Predefined "successful outcome" in each phase: composite measures indicating minimal or no opioid use based on urine test-confirmed self-reports. Results During phase 1, only 6.6% (43 of 653) of patients had successful outcomes, with no difference between SMM and SMM plus opioid dependence counseling. In contrast, 49.2% (177 of 360) attained successful outcomes in phase 2 during extended buprenorphine-naloxone treatment (week 12), with no difference between counseling conditions. Success rates 8 weeks after completing the buprenorphine-naloxone taper (phase 2, week 24) dropped to 8.6% (31 of 360), again with no counseling difference. In secondary analyses, successful phase 2 outcomes were more common while taking buprenorphine-naloxone than 8 weeks after taper (49.2% [177 of 360] vs 8.6% [31 of 360], P Conclusions Prescription opioid-dependent patients are most likely to reduce opioid use during buprenorphine-naloxone treatment; if tapered off buprenorphine-naloxone, even after 12 weeks of treatment, the likelihood of an unsuccessful outcome is high, even in patients receiving counseling in addition to SMM.read more
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Journal ArticleDOI
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
TL;DR: This guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.
Journal ArticleDOI
CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016.
TL;DR: This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.
Journal ArticleDOI
Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence
TL;DR: Buprenorphine maintenance compared to placebo and to methadone maintenance in the management of opioid dependence, including its ability to retain people in treatment, suppress illicit drug use, reduce criminal activity, and mortality is evaluated.
Journal ArticleDOI
Relationship between Nonmedical Prescription-Opioid Use and Heroin Use
TL;DR: A large fraction of heroin users now report that they formerly used prescription opioids nonmedically, a finding that has led to restrictions on opioid prescribing, but only a small fraction of prescription-opioid users move on to heroin use.
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