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Effective Applications of Medication-Assisted Opioid Dependence Counseling


NEW YORK - Patients dependent on prescription opioids are likely to quit if they get individual drug counseling with their prescribed medications, according to long-term follow-up results.

"Medication-assisted treatment for opioid dependence benefited people who were dependent on prescription opioids. Good standard medical management, medically based counseling, can be effective for these people if given in conjunction with buprenorphine treatment," said lead author Dr. Roger D. Weiss, professor of psychiatry at Harvard Medical School in Boston and chief of the Division of Alcohol and Drug Abuse at McLean Hospital in Belmont, Massachusetts.

"Over time, with treatment, these patients have relatively optimistic outcomes, but there are a number of risks involved, including people shifting from prescription opioids to heroin who had never injected drugs, injecting them, and a higher death rate," he told Reuters Health by phone.

Dr. Weiss and colleagues examined the outcomes over a 42-month follow-up period among adult participants in POATS (the Prescription Opioid Addiction Treatment Study), the first long-term multisite randomized trial to investigate whether outcomes for patients dependent on prescription opioid analgesics can be improved with standard medical management by adding individual drug counseling to prescribed buprenorphine (combined with naloxone to prevent withdrawal symptoms).

The researchers enrolled 653 participants at 12 medical centers in nine states through the National Institute on Drug Abuse (NIDA) Clinical Trials Network. They examined the results at four and 12 weeks and conducted follow-up assessments of opioid and other substance abuse through telephone interviews with 375 patients at 1.5 years, 2.5 years, and 3.5 years from study entry.

At 1.5 years, most follow-up participants no longer depended on opioids, and at 3.5 years, fewer than 10% of them were opioid dependent. Patients who reported a lifetime history of heroin use at study entry were more likely to be opioid dependent at 3.5 years (odds ratio 4.56, p<0.05).

At 2.5 years, 61% of patients reported that they had abstained from opioids for one month. The roughly one-third of the sample who received opioid agonist treatment during follow-up were more likely to be abstinent at month 42. Even so, 27 (8%) of 338 patients used heroin for the first time during follow-up and 10.1% reported that they had injected heroin for the first time.

The results were presented in a poster May 16 at the Annual Meeting of the American Psychiatric Association (APA) in Atlanta, Georgia.

"Prior to this study, there had never been a study of treatment in people dependent on prescription opioids. There had been many opioid-dependence treatment studies, but they had all focused on people who exclusively or primarily used heroin, and most were done in methadone maintenance programs. This was the first study done with people receiving office-based buprenorphine treatment," Dr. Weiss told Reuters Health.

"A real strength of this study is that it was very large and included a mixture of urban, suburban, and rural sites. No other study has looked at even 100 people," he added.

Regarding future related research, Dr. Weiss told Reuters Health that it would be good to learn exactly which people do well over time and how to increase their success rate.

The authors reported no funding or disclosures.


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