Health-related quality of life and opioid use disorder pharmacotherapy: A secondary analysis of a clinical trial. (1st October 2020)

• Record Type: Journal Article
• Authors: Jalali, Ali; Ryan, Danielle A.; Jeng, Philip J.; McCollister, Kathryn E.; Leff, Jared A.; Lee, Joshua D.; Nunes, Edward V.; Novo, Patricia; Rotrosen, John; Schackman, Bruce R.; Murphy, Sean M.
• Is Part Of: Drug and alcohol dependence. Volume 215(2020)
• Publication Date: 2020-10-01
• Subjects: Health-related quality-of-life -- Opioid use disorder -- Medications for opioid use disorder -- Regression mixture modeling -- Latent class analysis; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2020.108221
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Health-Related Quality of Life (HRQoL) can be classified into two longitudinal subpopulations. HRQoL may be improved through the use of pharmacotherapy for many persons with Opioid Use Disorder. An identifiable minority may require additional services to achieve HRQoL benefits of pharmacotherapy. Abstract: Objective: To examine the health-related quality-of-life (HRQoL) of persons with opioid use disorder (OUD) seeking treatment in an inpatient detoxification or short-term residential setting; continuing treatment as outpatients. Methods: We conducted a secondary analysis of data from a clinical trial (N = 508) where participants were randomized to extended-release naltrexone or buprenorphine-naloxone for the prevention of opioid relapse. We used a generalized structural equation regression mixture model to identify associations of HRQoL (EQ-5D) trajectories, including latent characteristics, over the 24-week trial and 36-week follow-up period, among participants who reported HRQoL beyond baseline. This novel framework accounted for baseline and time-varying characteristics, while simultaneously identifying latent classes. Results: We identified two subpopulations: HRQoL "pharmacotherapy responsive" (82.3 %) and HRQoL "characteristic sensitive" (17.7 %). The pharmacotherapy responsive subpopulation was characterized by a shortterm HRQoL improvement and then stable HRQoL over time, and by a positive association between HRQoL and receiving pharmacotherapy in the past 30 days. The characteristic sensitive subpopulation was characterized by an initial improvement in HRQoL with a gradual decline over time, and no significant HRQoL response to pharmacotherapy. HRQoL changes over time in this subpopulation were more influenced by baseline demographic, socioeconomic, and psychosocial characteristics. Conclusion: Our findings suggest that while HRQoL may be improved and sustained through targeted efforts to promote use of pharmacotherapy for many persons with OUD, an identifiable subpopulation may require additional services that address socioeconomic and psychosocial issues to achieve HRQoL benefits. Our analysis provides insight for improving individualized care for persons with opioid use disorder seeking treatment.