Predictors of Buprenorphine Initial Outpatient Maintenance and Dose Taper Response Among Non-treatment-seeking Heroin Dependent Volunteers

Overview

Journal Drug Alcohol Depend

Publisher Elsevier

Specialty Psychiatry

Date 2014 Dec 7

PMID 25479914

Citations 7

Authors

Eric A Woodcock

Leslie H Lundahl

Mark K Greenwald

Affiliations

Soon will be listed here.

Abstract

Background: Buprenorphine (BUP) is effective for treating opioid use disorder. Individuals' heroin-use characteristics may predict their responses to BUP, which could differ during maintenance and dose-taper phases. If so, treatment providers could use pre-treatment characteristics to personalize level of individual care and possibly improve treatment outcomes.

Methods: Non-treatment-seeking heroin-dependent volunteers (N=34) initiated outpatient BUP maintenance (8-mg/day) and submitted urine samples thrice weekly tested for opioids (non-contingent result). After completing three programmatically-related inpatient behavioral pharmacology experiments (while maintained on 8-mg/day BUP), participants were discharged and underwent a double-blind BUP dose taper (4-mg/day, 2-mg/day and 0-mg/day during weeks 1-3, respectively) with an opioid-abstinence incentive ($30 per consecutive opioid-negative urine specimen, obtained thrice weekly).

Results: Participants who reported less pre-study (past-month) heroin use and shorter lifetime duration of heroin use were more likely to submit an opioid-negative urine sample during initial outpatient BUP maintenance. Participants who reported more lifetime heroin-quit attempts and provided any opioid-free urine sample during initial outpatient maintenance sustained longer continuous opioid-abstinence during the BUP dose taper. Participants who reported >3 lifetime quit attempts abstained from opioid use nearly one week longer (14 days vs. 8 days to opioid-lapse) and nearly half (46.7%) refrained from opioid use during dose taper.

Conclusions: Number of prior heroin quit attempts may predict BUP dose taper response and provide a metric for stratifying heroin-dependent individuals by relative risk for opioid lapse. This metric may inform personalized relapse prevention care and improve treatment outcomes.

Citing Articles

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References

Bisaga A, Aharonovich E, Garawi F, Levin F, Rubin E, Raby W . Utility of lead-in period in cocaine dependence pharmacotherapy trials. Drug Alcohol Depend. 2004; 77(1):7-11. DOI: 10.1016/j.drugalcdep.2004.06.007. View

Ling W, Charuvastra C, Collins J, Batki S, Brown Jr L, Kintaudi P . Buprenorphine maintenance treatment of opiate dependence: a multicenter, randomized clinical trial. Addiction. 1998; 93(4):475-86. DOI: 10.1046/j.1360-0443.1998.9344753.x. View

Raehal K, Bohn L . Mu opioid receptor regulation and opiate responsiveness. AAPS J. 2005; 7(3):E587-91. PMC: 2751262. DOI: 10.1208/aapsj070360. View

Pani P, Maremmani I, Pirastu R, Tagliamonte A, Gessa G . Buprenorphine: a controlled clinical trial in the treatment of opioid dependence. Drug Alcohol Depend. 2000; 60(1):39-50. DOI: 10.1016/s0376-8716(99)00140-4. View

Sim-Selley L, Selley D, Vogt L, Childers S, Martin T . Chronic heroin self-administration desensitizes mu opioid receptor-activated G-proteins in specific regions of rat brain. J Neurosci. 2000; 20(12):4555-62. PMC: 6772440. View

Mark T, Woody G, Juday T, KLEBER H . The economic costs of heroin addiction in the United States. Drug Alcohol Depend. 2001; 61(2):195-206. DOI: 10.1016/s0376-8716(00)00162-9. View

Ehrman R, Robbins S, Cornish J . Results of a baseline urine test predict levels of cocaine use during treatment. Drug Alcohol Depend. 2001; 62(1):1-7. DOI: 10.1016/s0376-8716(00)00137-x. View

Nestler E . Molecular basis of long-term plasticity underlying addiction. Nat Rev Neurosci. 2001; 2(2):119-28. DOI: 10.1038/35053570. View

Marsch L, Bickel W, Badger G, Stothart M, Quesnel K, Stanger C . Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial. Arch Gen Psychiatry. 2005; 62(10):1157-64. DOI: 10.1001/archpsyc.62.10.1157. View

10.

Faul F, Erdfelder E, Lang A, Buchner A . G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39(2):175-91. DOI: 10.3758/bf03193146. View

11.

Soyka M, Zingg C, Koller G, Kuefner H . Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study. Int J Neuropsychopharmacol. 2008; 11(5):641-53. DOI: 10.1017/S146114570700836X. View

12.

Ziedonis D, Amass L, Steinberg M, Woody G, Krejci J, Annon J . Predictors of outcome for short-term medically supervised opioid withdrawal during a randomized, multicenter trial of buprenorphine-naloxone and clonidine in the NIDA clinical trials network drug and alcohol dependence. Drug Alcohol Depend. 2008; 99(1-3):28-36. PMC: 2770269. DOI: 10.1016/j.drugalcdep.2008.06.016. View

13.

Sigmon S, Dunn K, Badger G, Heil S, Higgins S . Brief buprenorphine detoxification for the treatment of prescription opioid dependence: a pilot study. Addict Behav. 2008; 34(3):304-11. PMC: 2643343. DOI: 10.1016/j.addbeh.2008.11.017. View

14.

Greenwald M . Opioid abstinence reinforcement delays heroin lapse during buprenorphine dose tapering. J Appl Behav Anal. 2009; 41(4):603-7. PMC: 2606597. DOI: 10.1901/jaba.2008.41-603. View

15.

Greenwald M, Steinmiller C . Behavioral economic analysis of opioid consumption in heroin-dependent individuals: effects of alternative reinforcer magnitude and post-session drug supply. Drug Alcohol Depend. 2009; 104(1-2):84-93. PMC: 2724970. DOI: 10.1016/j.drugalcdep.2009.04.006. View

16.

Meader N . A comparison of methadone, buprenorphine and alpha(2) adrenergic agonists for opioid detoxification: a mixed treatment comparison meta-analysis. Drug Alcohol Depend. 2010; 108(1-2):110-4. DOI: 10.1016/j.drugalcdep.2009.12.008. View

17.

Greenwald M . Effects of experimental Unemployment, Employment and Punishment analogs on opioid seeking and consumption in heroin-dependent volunteers. Drug Alcohol Depend. 2010; 111(1-2):64-73. PMC: 2930063. DOI: 10.1016/j.drugalcdep.2010.03.020. View

18.

Subramaniam G, Warden D, Minhajuddin A, Fishman M, Stitzer M, Adinoff B . Predictors of abstinence: National Institute of Drug Abuse multisite buprenorphine/naloxone treatment trial in opioid-dependent youth. J Am Acad Child Adolesc Psychiatry. 2011; 50(11):1120-8. PMC: 3786351. DOI: 10.1016/j.jaac.2011.07.010. View

19.

Dunn K, Sigmon S, Strain E, Heil S, Higgins S . The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: a review. Drug Alcohol Depend. 2011; 119(1-2):1-9. PMC: 3205338. DOI: 10.1016/j.drugalcdep.2011.05.033. View

20.

Fareed A, Vayalapalli S, Casarella J, Drexler K . Effect of buprenorphine dose on treatment outcome. J Addict Dis. 2012; 31(1):8-18. DOI: 10.1080/10550887.2011.642758. View