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Predictors of buprenorphine initial outpatient maintenance and dose taper response among non-treatment-seeking heroin dependent volunteers.
Drug Alcohol Depend 2015; 146:89-96DA

Abstract

BACKGROUND

Buprenorphine (BUP) is effective for treating opioid use disorder. Individuals' heroin-use characteristics may predict their responses to BUP, which could differ during maintenance and dose-taper phases. If so, treatment providers could use pre-treatment characteristics to personalize level of individual care and possibly improve treatment outcomes.

METHODS

Non-treatment-seeking heroin-dependent volunteers (N=34) initiated outpatient BUP maintenance (8-mg/day) and submitted urine samples thrice weekly tested for opioids (non-contingent result). After completing three programmatically-related inpatient behavioral pharmacology experiments (while maintained on 8-mg/day BUP), participants were discharged and underwent a double-blind BUP dose taper (4-mg/day, 2-mg/day and 0-mg/day during weeks 1-3, respectively) with an opioid-abstinence incentive ($30 per consecutive opioid-negative urine specimen, obtained thrice weekly).

RESULTS

Participants who reported less pre-study (past-month) heroin use and shorter lifetime duration of heroin use were more likely to submit an opioid-negative urine sample during initial outpatient BUP maintenance. Participants who reported more lifetime heroin-quit attempts and provided any opioid-free urine sample during initial outpatient maintenance sustained longer continuous opioid-abstinence during the BUP dose taper. Participants who reported >3 lifetime quit attempts abstained from opioid use nearly one week longer (14 days vs. 8 days to opioid-lapse) and nearly half (46.7%) refrained from opioid use during dose taper.

CONCLUSIONS

Number of prior heroin quit attempts may predict BUP dose taper response and provide a metric for stratifying heroin-dependent individuals by relative risk for opioid lapse. This metric may inform personalized relapse prevention care and improve treatment outcomes.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA; Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA.Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA.Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA; Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA; Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA. Electronic address: mgreen@med.wayne.edu.

Pub Type(s)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25479914

Citation

Woodcock, Eric A., et al. "Predictors of Buprenorphine Initial Outpatient Maintenance and Dose Taper Response Among Non-treatment-seeking Heroin Dependent Volunteers." Drug and Alcohol Dependence, vol. 146, 2015, pp. 89-96.
Woodcock EA, Lundahl LH, Greenwald MK. Predictors of buprenorphine initial outpatient maintenance and dose taper response among non-treatment-seeking heroin dependent volunteers. Drug Alcohol Depend. 2015;146:89-96.
Woodcock, E. A., Lundahl, L. H., & Greenwald, M. K. (2015). Predictors of buprenorphine initial outpatient maintenance and dose taper response among non-treatment-seeking heroin dependent volunteers. Drug and Alcohol Dependence, 146, pp. 89-96. doi:10.1016/j.drugalcdep.2014.11.016.
Woodcock EA, Lundahl LH, Greenwald MK. Predictors of Buprenorphine Initial Outpatient Maintenance and Dose Taper Response Among Non-treatment-seeking Heroin Dependent Volunteers. Drug Alcohol Depend. 2015 Jan 1;146:89-96. PubMed PMID: 25479914.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of buprenorphine initial outpatient maintenance and dose taper response among non-treatment-seeking heroin dependent volunteers. AU - Woodcock,Eric A, AU - Lundahl,Leslie H, AU - Greenwald,Mark K, Y1 - 2014/11/26/ PY - 2014/08/18/received PY - 2014/11/17/revised PY - 2014/11/18/accepted PY - 2014/12/7/entrez PY - 2014/12/7/pubmed PY - 2015/12/19/medline KW - Abstinence KW - Buprenorphine KW - Dose taper KW - Heroin KW - Maintenance KW - Relapse SP - 89 EP - 96 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 146 N2 - BACKGROUND: Buprenorphine (BUP) is effective for treating opioid use disorder. Individuals' heroin-use characteristics may predict their responses to BUP, which could differ during maintenance and dose-taper phases. If so, treatment providers could use pre-treatment characteristics to personalize level of individual care and possibly improve treatment outcomes. METHODS: Non-treatment-seeking heroin-dependent volunteers (N=34) initiated outpatient BUP maintenance (8-mg/day) and submitted urine samples thrice weekly tested for opioids (non-contingent result). After completing three programmatically-related inpatient behavioral pharmacology experiments (while maintained on 8-mg/day BUP), participants were discharged and underwent a double-blind BUP dose taper (4-mg/day, 2-mg/day and 0-mg/day during weeks 1-3, respectively) with an opioid-abstinence incentive ($30 per consecutive opioid-negative urine specimen, obtained thrice weekly). RESULTS: Participants who reported less pre-study (past-month) heroin use and shorter lifetime duration of heroin use were more likely to submit an opioid-negative urine sample during initial outpatient BUP maintenance. Participants who reported more lifetime heroin-quit attempts and provided any opioid-free urine sample during initial outpatient maintenance sustained longer continuous opioid-abstinence during the BUP dose taper. Participants who reported >3 lifetime quit attempts abstained from opioid use nearly one week longer (14 days vs. 8 days to opioid-lapse) and nearly half (46.7%) refrained from opioid use during dose taper. CONCLUSIONS: Number of prior heroin quit attempts may predict BUP dose taper response and provide a metric for stratifying heroin-dependent individuals by relative risk for opioid lapse. This metric may inform personalized relapse prevention care and improve treatment outcomes. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/25479914/Predictors_of_buprenorphine_initial_outpatient_maintenance_and_dose_taper_response_among_non_treatment_seeking_heroin_dependent_volunteers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(14)01928-0 DB - PRIME DP - Unbound Medicine ER -