Opioid Abstinence Reinforcement Delays Heroin Lapse During Buprenorphine Dose Tapering

Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan 48207, USA.
Journal of Applied Behavior Analysis (Impact Factor: 1.19). 02/2008; 41(4):603-7. DOI: 10.1901/jaba.2008.41-603
Source: PubMed


A positive reinforcement contingency increased opioid abstinence during outpatient dose tapering (4, 2, then 0 mg/day during Weeks 1 through 3) in non-treatment-seeking heroin-dependent volunteers who had been maintained on buprenorphine (8 mg/day) during an inpatient research protocol. The control group (n=12) received $4.00 for completing assessments at each thrice-weekly visit during dose tapering; 10 of 12 lapsed to heroin use 1 day after discharge. The abstinence reinforcement group (n=10) received $30.00 for each consecutive opioid-free urine sample; this significantly delayed heroin lapse (median, 15 days).

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Available from: Mark K Greenwald
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    • "After a weekend washout period to clear residual hydromorphone from the final experimental session (urinalysis confirmed), participants were discharged and underwent outpatient BUP dose taper under double-blind conditions using small (2-mg or matched-placebo) mono tablets: 4 mg/day (Week 1; two active tablets) to 2 mg/day (Week 2; one active and one matched-placebo tablet) to 0 mg/day (Week 3; two matched-placebo tablets); this taper was identical across source studies. Abstinence-contingent reinforcement ($30 per consecutive opioid-negative urine sample measured thrice weekly M–W–F) was used to discourage opioid lapse during BUP dose taper, based on prior work (Stitzer et al., 1980; Greenwald, 2008). The abstinent-contingent incentive was explained to participants during the informed consent procedures and prior to inpatient discharge, and was identical across source studies. "
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    ABSTRACT: 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. 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). 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. 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. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Nov 2014 · Drug and Alcohol Dependence
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    • "Data were collected during the screening phase for three similar laboratorybased opioid pharmacology research studies, which were registered as NIH clinical trials NCT00218309 (Greenwald and Hursh, 2006), NCT00218361 (Greenwald and Steinmiller, 2009), and NCT00608504 (Greenwald, 2010). For each study, candidates were told during the initial telephone interview and again during in-person screening that the study involved a minimum 10-day outpatient induction onto buprenorphine, two further weeks of buprenorphine maintenance during a continuous inpatient stay, and a standardized three-week outpatient buprenorphine dose taper (Greenwald, 2008). Screening for these studies was conducted from 2004 to 2008 during the initial few years after sublingual buprenorphine tablets received FDA approval (October 2002) and entered the U.S. market (early 2003) for treating opioid dependence. "
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    ABSTRACT: Heroin abuse remains an important public health problem, particularly in economically disadvantaged areas. Insight into this problem is gained from interviewing addicted individuals. However, we lack systematic data on factors that motivate heroin users to participate in non-treatment research that offers both financial incentives (compensation) and non-financial incentives (e.g., short-term medication). To better understand the relative importance of several types of personal motivations to participate in non-treatment buprenorphine research, and to relate self-motivations to social, economic, demographic and drug use factors. Heroin dependent volunteers (N=235 total; 57 female and 178 male; 136 African American, 86 Caucasian, and 13 Other) applied for non-therapeutic buprenorphine research in an urban outpatient setting from 2004 to 2008. We conducted a semi-structured behavioral economic interview, after which participants ranked 11 possible motivations for research participation. Although the study was repeatedly described as non-treatment research involving buprenorphine, participants often ranked some treatment-related motivations as important (wanting to reduce/stop heroin use, needing a medication to get stabilized/detoxify). Some motivations correlated with income, heroin use, and years since marketing of buprenorphine. Two dimensions emerged from principal component analysis of motivation rankings: (1) treatment motivation vs. greater immediate needs and (2) commitment to trying alternatives vs. a more accepting attitude toward traditional interventions. In summary, heroin addicts' self-motivations to engage in non-therapeutic research are complex--they value economic gain but not exclusively or primarily--and relate to variables such as socioeconomic factors and drug use.
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    • "Patak, & Leraas, 2008). Other papers show that these interventions can be used to treat adults who persist in using heroin and cocaine while in methadone maintenance treatment programs (Donlin, Knealing, Needham, Wong, & Silverman , 2008; Ghitza et al., 2008; Preston, Ghitza, Schmittner, Schroeder, & Epstein, 2008), adults enrolled in community drug abuse treatment clinics for a variety of different types of drug addiction (Ledgerwood, Alessi, Hanson, Godley, & Petry, 2008), opiatedependent adults undergoing outpatient opiate detoxification (Greenwald, 2008), and criminal offenders enrolled in drug court programs (Marlowe, Festinger, Dugosh, Arabia, & Kirby, 2008). "
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    ABSTRACT: Extensive evidence from the laboratory and the clinic suggests that drug addiction can be viewed as operant behavior and effectively treated through the application of principles of operant conditioning. Contingency management interventions that arrange for the direct reinforcement of drug abstinence or of other therapeutically important target behaviors (e.g., regular use of drug abuse treatment medications) are among the most studied type of operant treatments. Behavior analysts have contributed to the substantial and rapidly growing literature on operant treatments for drug addiction, but the publications of this work usually appear in medical, clinical psychology, or drug abuse journals. This special issue of the Journal of Applied Behavior Analysis represents an effort to bring this important work to the attention of the behavior-analytic community. The articles in this special issue illustrate both the enormous potential of contingency management interventions to address the serious and seemingly intractable problem of drug addiction as well as the real challenges involved in attempting to develop and disseminate treatments that will produce substantial and lasting changes in the lives of individuals plagued by the chronic problem of drug addiction.
    Full-text · Article · Feb 2008 · Journal of Applied Behavior Analysis
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