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Am J Addict. 2014 Jul-Aug;23(4):343-8. doi: 10.1111/j.1521-0391.2013.12105.x. Epub 2013 Sep 24.

The relationship between primary prescription opioid and buprenorphine-naloxone induction outcomes in a prescription opioid dependent sample.

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  • 1UCLA Integrated Substance Abuse Programs, Los Angeles, California; University of Sydney, Camperdown, New South Wales, Australia.

Abstract

BACKGROUND AND OBJECTIVES:

This analysis aims to: (1) compare induction experiences among participants who self-reported using one of the four most commonly reported POs, and (2) examine factors associated with difficult bup-nx induction. Our hypothesis, based on previous research and current guidelines, is that those on longer-acting opioids will have experienced more difficult inductions.

METHODS:

The Prescription Opioid Addiction Treatment Study (POATS) was a multi-site, randomized clinical trial, using a two-phase adaptive treatment research design. This analysis examines bup-nx induction of participants who self-reported primary PO use of methadone, ER-oxycodone, IR-oxycodone, and hydrocodone (n = 69). Analyses examined characteristics associated with difficult induction, defined as increased withdrawal symptoms measured by the Clinical Opiate Withdrawal Scale (COWS) after the first bup-nx dose with higher scores denoting greater withdrawal symptoms/severity.

RESULTS:

Contrary to our hypothesis, difficult induction experiences did not differ by primary PO type. Those who experienced a post-induction increase in COWS score had lower pre-dose COWS scores compared to those who did not experience a post-induction increase in COWS score (10.09 vs. 12.77, t(624) = -13.56, p < .001). Demographics characteristics, depression, and pain history did not predict a difficult induction.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE:

Difficult bup-nx inductions were not associated with participants' primary PO. Severity of withdrawal, measured with the COWS, was an important variable, reminding clinicians that bup-nx should not be commenced prior to evidence of moderate opioid withdrawal. These findings add to the evidence that with careful procedures, bup-nx can used with few difficulties in PO-dependent patients. (Am J Addict 2014;23:343-348).

© American Academy of Addiction Psychiatry.

KEYWORDS:

buprenorphine; induction; prescription opioid dependence

PMID:
24112096
[PubMed - indexed for MEDLINE]
PMCID:
PMC4151625
Free PMC Article
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