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Drug Alcohol Depend. 2015 Mar 1;148:62-8. doi: 10.1016/j.drugalcdep.2014.12.018. Epub 2014 Dec 30.

Using behavioral economics to predict opioid use during prescription opioid dependence treatment.

Author information

1
Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024, United States. Electronic address: mworley@mednet.ucla.edu.
2
Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024, United States.
3
Addiction Recovery Research Center (ARRC), Virginia Tech Carillion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States.
4
Integrated Substance Abuse Program, University of California, Los Angeles, 1640 S. Sepulveda, Ste. 120, Los Angeles, CA 90024, United States.

Abstract

BACKGROUND:

Research grounded in behavioral economics has previously linked addictive behavior to disrupted decision-making and reward-processing, but these principles have not been examined in prescription opioid addiction, which is currently a major public health problem. This study examined whether pre-treatment drug reinforcement value predicted opioid use during outpatient treatment of prescription opioid addiction.

METHODS:

Secondary analyses examined participants with prescription opioid dependence who received 12 weeks of buprenorphine-naloxone and counseling in a multi-site clinical trial (N=353). Baseline measures assessed opioid source and indices of drug reinforcement value, including the total amount and proportion of income spent on drugs. Weekly urine drug screens measured opioid use.

RESULTS:

Obtaining opioids from doctors was associated with lower pre-treatment drug spending, while obtaining opioids from dealers/patients was associated with greater spending. Controlling for demographics, opioid use history, and opioid source frequency, patients who spent a greater total amount (OR=1.30, p<.001) and a greater proportion of their income on drugs (OR=1.31, p<.001) were more likely to use opioids during treatment.

CONCLUSIONS:

Individual differences in drug reinforcement value, as indicated by pre-treatment allocation of economic resources to drugs, reflects propensity for continued opioid use during treatment among individuals with prescription opioid addiction. Future studies should examine disrupted decision-making and reward-processing in prescription opioid users more directly and test whether reinforcer pathology can be remediated in this population.

KEYWORDS:

Behavioral economics; Buprenorphine–naloxone; Prescription opioids; Treatment outcome

PMID:
25622776
PMCID:
PMC4666717
DOI:
10.1016/j.drugalcdep.2014.12.018
[Indexed for MEDLINE]
Free PMC Article

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