The relationship between primary prescription opioid and buprenorphine–naloxone induction outcomes in a prescription opioid dependent sample. (24th September 2013)

• Record Type: Journal Article
• Authors: Nielsen, Suzanne; Hillhouse, Maureen; Weiss, Roger D.; Mooney, Larissa; Sharpe Potter, Jennifer; Lee, Joshua; Gourevitch, Marc N.; Ling, Walter
• Is Part Of: American journal on addictions. Volume 23:Number 4(2014:Jul./Aug.)
• Page Start: 343
• Page End: 348
• Publication Date: 2013-09-24
• Subjects: Substance abuse -- Periodicals; Substance abuse -- Treatment -- Periodicals; 616.86005
• DOI: 10.1111/j.1521-0391.2013.12105.x
• Languages: English
• ISSNs: 1055-0496

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ajad12105-sec-0001" sec-type="section"> <title>Background and objectives</title> <p>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.</p> </sec> <sec id="ajad12105-sec-0002" sec-type="section"> <title>Methods</title> <p>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 (<italic>n</italic> = 569). 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.</p> </sec> <sec id="ajad12105-sec-0003" sec-type="section"> <title>Results</title> <p>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, <italic>t</italic>(624) = −13.56, <italic>p</italic> < .001). Demographics characteristics, depression, and pain history did not predict a difficult induction.</p> </sec> <sec id="ajad12105-sec-0004" sec-type="section"> <title>Conclusions and scientific significance</title> <p>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)</p> </sec> </abstract>