Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study

Drug Alcohol Depend. 2015 May 1;150:112-9. doi: 10.1016/j.drugalcdep.2015.02.030. Epub 2015 Mar 6.

Abstract

Background: Despite the growing prevalence of prescription opioid dependence, longitudinal studies have not examined long-term treatment response. The current study examined outcomes over 42 months in the Prescription Opioid Addiction Treatment Study (POATS).

Methods: POATS was a multi-site clinical trial lasting up to 9 months, examining different durations of buprenorphine-naloxone plus standard medical management for prescription opioid dependence, with participants randomized to receive or not receive additional opioid drug counseling. A subset of participants (N=375 of 653) enrolled in a follow-up study. Telephone interviews were administered approximately 18, 30, and 42 months after main-trial enrollment. Comparison of baseline characteristics by follow-up participation suggested few differences.

Results: At Month 42, much improvement was seen: 31.7% were abstinent from opioids and not on agonist therapy; 29.4% were receiving opioid agonist therapy, but met no symptom criteria for current opioid dependence; 7.5% were using illicit opioids while on agonist therapy; and the remaining 31.4% were using opioids without agonist therapy. Participants reporting a lifetime history of heroin use at baseline were more likely to meet DSM-IV criteria for opioid dependence at Month 42 (OR=4.56, 95% CI=1.29-16.04, p<.05). Engagement in agonist therapy was associated with a greater likelihood of illicit-opioid abstinence. Eight percent (n=27/338) used heroin for the first time during follow-up; 10.1% reported first-time injection heroin use.

Conclusions: Long-term outcomes for those dependent on prescription opioids demonstrated clear improvement from baseline. However, a subset exhibited a worsening course, by initiating heroin use and/or injection opioid use.

Keywords: Addiction; Follow-up; Heroin; Opioids; Prescription opioids; Treatment.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analgesics, Opioid / therapeutic use*
  • Behavior, Addictive / drug therapy
  • Behavior, Addictive / psychology
  • Behavior, Addictive / therapy*
  • Counseling*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Opiate Substitution Treatment*
  • Opioid-Related Disorders / drug therapy
  • Opioid-Related Disorders / psychology
  • Opioid-Related Disorders / therapy*
  • Treatment Outcome
  • Young Adult

Substances

  • Analgesics, Opioid