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J Clin Psychiatry. 2019 Mar 26;80(2). pii: 18m12292. doi: 10.4088/JCP.18m12292.

Correlates of Opioid Abstinence in a 42-Month Posttreatment Naturalistic Follow-Up Study of Prescription Opioid Dependence.

Author information

1
McLean Hospital, 115 Mill St, Belmont, MA 02478. rweiss@mclean.harvard.edu.
2
Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.
3
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
4
Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
5
Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
6
Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts, USA.
7
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.

Abstract

OBJECTIVE:

The natural course of prescription opioid use disorder has not been examined in longitudinal studies. The current study examined correlates of opioid abstinence over time after completion of a treatment trial for prescription opioid dependence.

METHODS:

The multisite Prescription Opioid Addiction Treatment Study examined different durations of buprenorphine-naloxone treatment and different intensities of counseling to treat prescription opioid dependence, as assessed by DSM-IV; following the clinical trial, a longitudinal study was conducted from March 2009-January 2013. At 18, 30, and 42 months after treatment entry, telephone interviews were conducted (N = 375). In this exploratory, naturalistic study, logistic regression analyses examined the association between treatment modality (including formal treatment and mutual help) and opioid abstinence rates at the follow-up assessments.

RESULTS:

At the 3 follow-up assessments, approximately half of the participants reported engaging in current substance use disorder treatment (47%-50%). The most common treatments were buprenorphine maintenance (27%-35%) and mutual-help group attendance (27%-30%), followed by outpatient counseling (18%-23%) and methadone maintenance (4%). In adjusted analyses, current opioid agonist treatment showed the strongest association with current opioid abstinence (odds ratios [ORs] = 5.4, 4.6, and 2.8 at the 3 assessments), followed by current mutual-help attendance (ORs = 2.2, 2.7, and 1.9); current outpatient counseling was not significantly associated with abstinence in the adjusted models.

CONCLUSIONS:

While opioid agonist treatment was most strongly associated with opioid abstinence among patients with prescription opioid dependence over time, mutual-help group attendance was independently associated with opioid abstinence. Clinicians should consider recommending both of these interventions to patients with opioid use disorder.

TRIAL REGISTRATION:

ClinicalTrials.gov identifier: NCT00316277​.

PMID:
30920187
DOI:
10.4088/JCP.18m12292
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