Prescription opioid misuse is a growing problem in the U.S. with rates of overdose exceeding those of heroin and cocaine combined.
Prescription opioid misuse is a growing problem in the U.S. with rates of overdose exceeding those of heroin and cocaine combined.
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McDermott et al. examined the predictive value of initial response to buprenorphine-naloxone (i.e., Suboxone) treatment for 12-week treatment outcomes among individuals meeting DSM-IV criteria for opioid dependence (with prescription opioids as the primary substance used).
Participants were part of the Prescription Opioid Addiction Treatment Study, a multi-site randomized controlled trial consisting of a brief treatment phase (2 weeks of buprenorphine-naloxone, 2 week taper, and 8 weeks of follow-up) and an extended treatment phase (12 weeks of buprenorphine-naloxone stabilization, 4 week taper, and 8 weeks of follow-up) which was offered to those who did not achieve abstinence or near-abstinence in the first phase. Participants were randomized to receive weekly Standard Medical Management (SMM) or SMM and Opioid Dependence Counseling (ODC).
Since over 90% of participants were unsuccessful in the first phase of treatment, only participants (n = 360) from the extended treatment phase were used in this analysis. Participants were 33 years old on average (range: 18 to 64), 58% male, and 91% Caucasian. A majority (81%) did not report past-year non-opioid use disorders.
The authors examined initial response to treatment in four time periods:
The authors operationalized treatment response and success as follows:
Opioid use during weeks 1 and 2 was a strong predictor of not achieving success at the end of treatment and an even stronger predictor of non-abstinence. For both outcomes, the gains from increasing the initial period were modest with Negative Predictive Value (NPV) increasing by 4 percentage points for the successful treatment outcome and 3 percentage points for abstinence.
The choice of population for this study (ie., primarily prescription opioid users vs. heroin users alone or a mixed population) is novel and timely. The ability to make an evidence-based clinical modification earlier in the course of treatment can save time and money, but more importantly, could save the life of the patient.
McDermott, K. A., Griffin, M. L., Connery, H. S., Hilario, E. Y., Fiellin, D. A., Fitzmaurice, G. M., & Weiss, R. D. (2014). Initial response as a predictor of 12-week buprenorphine-naloxone treatment response in a prescription opioid-dependent population. The Journal of clinical psychiatry
l
McDermott et al. examined the predictive value of initial response to buprenorphine-naloxone (i.e., Suboxone) treatment for 12-week treatment outcomes among individuals meeting DSM-IV criteria for opioid dependence (with prescription opioids as the primary substance used).
Participants were part of the Prescription Opioid Addiction Treatment Study, a multi-site randomized controlled trial consisting of a brief treatment phase (2 weeks of buprenorphine-naloxone, 2 week taper, and 8 weeks of follow-up) and an extended treatment phase (12 weeks of buprenorphine-naloxone stabilization, 4 week taper, and 8 weeks of follow-up) which was offered to those who did not achieve abstinence or near-abstinence in the first phase. Participants were randomized to receive weekly Standard Medical Management (SMM) or SMM and Opioid Dependence Counseling (ODC).
Since over 90% of participants were unsuccessful in the first phase of treatment, only participants (n = 360) from the extended treatment phase were used in this analysis. Participants were 33 years old on average (range: 18 to 64), 58% male, and 91% Caucasian. A majority (81%) did not report past-year non-opioid use disorders.
The authors examined initial response to treatment in four time periods:
The authors operationalized treatment response and success as follows:
Opioid use during weeks 1 and 2 was a strong predictor of not achieving success at the end of treatment and an even stronger predictor of non-abstinence. For both outcomes, the gains from increasing the initial period were modest with Negative Predictive Value (NPV) increasing by 4 percentage points for the successful treatment outcome and 3 percentage points for abstinence.
The choice of population for this study (ie., primarily prescription opioid users vs. heroin users alone or a mixed population) is novel and timely. The ability to make an evidence-based clinical modification earlier in the course of treatment can save time and money, but more importantly, could save the life of the patient.
McDermott, K. A., Griffin, M. L., Connery, H. S., Hilario, E. Y., Fiellin, D. A., Fitzmaurice, G. M., & Weiss, R. D. (2014). Initial response as a predictor of 12-week buprenorphine-naloxone treatment response in a prescription opioid-dependent population. The Journal of clinical psychiatry
l
McDermott et al. examined the predictive value of initial response to buprenorphine-naloxone (i.e., Suboxone) treatment for 12-week treatment outcomes among individuals meeting DSM-IV criteria for opioid dependence (with prescription opioids as the primary substance used).
Participants were part of the Prescription Opioid Addiction Treatment Study, a multi-site randomized controlled trial consisting of a brief treatment phase (2 weeks of buprenorphine-naloxone, 2 week taper, and 8 weeks of follow-up) and an extended treatment phase (12 weeks of buprenorphine-naloxone stabilization, 4 week taper, and 8 weeks of follow-up) which was offered to those who did not achieve abstinence or near-abstinence in the first phase. Participants were randomized to receive weekly Standard Medical Management (SMM) or SMM and Opioid Dependence Counseling (ODC).
Since over 90% of participants were unsuccessful in the first phase of treatment, only participants (n = 360) from the extended treatment phase were used in this analysis. Participants were 33 years old on average (range: 18 to 64), 58% male, and 91% Caucasian. A majority (81%) did not report past-year non-opioid use disorders.
The authors examined initial response to treatment in four time periods:
The authors operationalized treatment response and success as follows:
Opioid use during weeks 1 and 2 was a strong predictor of not achieving success at the end of treatment and an even stronger predictor of non-abstinence. For both outcomes, the gains from increasing the initial period were modest with Negative Predictive Value (NPV) increasing by 4 percentage points for the successful treatment outcome and 3 percentage points for abstinence.
The choice of population for this study (ie., primarily prescription opioid users vs. heroin users alone or a mixed population) is novel and timely. The ability to make an evidence-based clinical modification earlier in the course of treatment can save time and money, but more importantly, could save the life of the patient.
McDermott, K. A., Griffin, M. L., Connery, H. S., Hilario, E. Y., Fiellin, D. A., Fitzmaurice, G. M., & Weiss, R. D. (2014). Initial response as a predictor of 12-week buprenorphine-naloxone treatment response in a prescription opioid-dependent population. The Journal of clinical psychiatry