NIDA Grants: U10DA015831, K24DA022288, U10DA020024, K23DA022297, U10DA013045

Predictors of Outcome in the Multi-Site CTN Prescription Opioid Addiction Treatment

StudyR Weiss1, J Potter1,2 M Griffin1, H Connery1, W Ling3

1McLean Hospital Division of Alcohol and Drug Abuse & Harvard Medical School, 2University of Texas Health Science Center, 3UCLA

Predictors of Outcome in the Multi-Site CTN Prescription Opioid Addiction Treatment

StudyR Weiss1, J Potter1,2 M Griffin1, H Connery1, W Ling3

1McLean Hospital Division of Alcohol and Drug Abuse & Harvard Medical School, 2University of Texas Health Science Center, 3UCLA

Abstract

Sample Characteristics

POATS Study Design

Key eligibility criteria DSM-IV opioid dependence, with physical dependence ≤4 days of heroin use in past 30 days No history of heroin injection

Sociodemographic Female 42% White 91% Education, years (mean, sd) 12.9, 2.2 Employed full time 60%

Clinical Lifetime heroin use 26% Current chronic pain 41% Duration of opioid use (median) 2-4 years

Findings

AIM To examine baseline predictors of outcome for prescription opioid dependent patients treated with buprenorphine/naloxone for 12 weeks (phase 2)METHOD Interviews and self-administered questionnaires were used to collect data on sociodemographic and clinical characteristics in a 2-phase randomized medication+ counseling trial.RESULTS Successful outcomes were more likely among those who had no prior treatment for opioid use disorder (including attending self-help meetings), had never used a route other than that prescribed, did not use primarily sustained-release oxycodone, had lifetime depression, whose first source of opioids was a legitimate medical prescription, who first used to relieve physical pain, and were older.CONCLUSION Among patients with prescription opioid dependence, characteristics traditionally associated with opioid addiction were associated with poorer outcomes.

Successful outcomes associated with

Older age Lifetime history of depression No prior treatment for opioid use disorder Route of use is oral or sublingual only

Conclusions

Successful Outcomes

Definition of Phase 1 success (at week 12) ≤4 days/month of opioid use Absence of 2 consecutive opioid-positive urine tests ≤1 missing urine sample during 12 weeks No other substance use disorder treatment (other than self-help)

Definition of Phase 2 success (at weeks 12 and 24) Abstinent for final week by urine-confirmed self-report Abstinent ≥2 of the 3 previous weeks

Findings for rates of successful outcomes Phase 1, week 12 6.6% Phase 2, week 12, end of treatment 49.2% Phase 2, week 24, end of taper 8.6%

Weiss et al., Archives of General Psychiatry, in press

Final logistic regression modelto predict success (N=360)

Baseline characteristics Odds ratio 95% CIs

Age + 10 years 1.28* 1.00-1.64

Lifetime depression 1.83* 1.15-2.89

Prior opioid use disorder treatment .62* .39-.99

Non-recommended route of use .51^ .26-1.01

Model R2 9.7%**

^p=.052 *p<.05 **p<.01

Other significant predictors by outcome

Patient characteristicsSuccessful

(n=177)Not

(n=183)

Age, mean (sd)** 33.9 (10.0) 31.2 (9.1)

1st source of opioids* Medical Rx 62% 49%

Dealer 6% 14%

1st reason to use opioids* For pain 70% 60%

To get high 24% 33%

*p<.05 **p<.01