A Comparison of Buprenorphine Taper Outcomes Between Prescription Opioid and Heroin Users

and University of Sydney, Sydney, New South Wales, Australia (SN).
Journal of Addiction Medicine (Impact Factor: 1.76). 12/2012; 7(1). DOI: 10.1097/ADM.0b013e318277e92e
Source: PubMed


Dependence on prescription opioids (PO) is a growing problem. Although most research with buprenorphine has focused on heroin-dependent populations, we hypothesize that individuals dependent on PO display characteristics that may predict different outcomes in treatment, particularly in short-term taper procedures in which comorbidities such as pain conditions may complicate taper.

This secondary data analysis examined differences in outcomes between PO users (n = 90) and heroin users (n = 426) after a buprenorphine taper. Data were collected in a multisite randomized clinical trial conducted by the National Drug Abuse Treatment Clinical Trials Network at 11 study sites across the United States. After a 4-week buprenorphine induction/stabilization phase, 516 opioid-dependent individuals were randomized into 1 of 2 taper lengths (7 vs 28 days) to assess the association between taper length and outcome. The primary outcome was measured by urine drug test for opioids at the end of the taper period. Craving, withdrawal, and buprenorphine dose were also examined.

After controlling for baseline demographic and drug use differences between the opioid use groups, results indicate that a higher percentage of the PO group (49%) provided an opioid-free urine drug specimen at the end of taper compared with the heroin group (36%; χ(2)(1) = 6.592, P < 0.010).

Short-term taper is not recommended as a stand-alone treatment; however, patients may taper from buprenorphine as part of a treatment plan. Despite greater comorbidity, PO users seem to have favorable taper outcomes compared with heroin users. Further studies are required to examine longer-term treatment outcomes.

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    • "Third, primary PO abusers may respond favorably to a detoxification treatment approach. For example, previously-reported comparisons of primary PO and heroin abusers have noted that PO abusers experienced less severe withdrawal during buprenorphine induction, provided more opioid-negative urine samples during a buprenorphine taper, were more likely to be retained in a buprenorphine taper, and were more likely to be opioid-negative at the end of a buprenorphine taper, compared to primary heroin abusers (Nielsen et al., 2012, 2013, 2014). Finally, the recent increases in adolescent opioid abuse warrant exploring potential alternatives to long-term maintenance (Zacny et al., 2003; McLellan and Turner, 2008; Volkow and McLellan, 2011), particularly given evidence that long-term opioid maintenance may alter cognitive functions (Gruber et al., 2007). "
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    ABSTRACT: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification. This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N=28). Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper. Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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