Buprenorphine/Naloxone and Methadone Maintenance Treatment Outcomes for Opioid Analgesic, Heroin, and Combined Users: Findings From Starting Treatment With Agonist Replacement Therapies (START) Jennifer Sharpe Potter, PhD, MPH Associate Professor Division of Alcohol and Drug Addiction Department of Psychiatry Assistant Dean for Research and Student Programs School of Medicine University of Texas Health Science Center San Antonio 1/28/2014
Conflict of Interest No conflicts Dr. Potter receives funding for her research from the National Institute on Drug Abuse
Participant Characteristics
Participant Characteristics
Baseline Substance Use
Baseline Substance Use
Treatment Retention
Opiate Positive UDS (%) GEE Analysis Bup*time χ 2 =92.41, p<.0001
Main Trial Summary Buprenorphine treatment can be successfully integrated into the licensed OTP setting Treatment retention worse with buprenorphine vs. methadone Retention improved with higher doses In open label trial with adequate dose levels less illicit opiate and cocaine use seen in buprenorphine vs methadone groups Confounded by greater dropout in buprenorphine arm Opiate difference seen only during first 10 weeks of tx Higher doses associated with less opiate use Cocaine difference existed at pre-randomization BL
Main Trial Summary No differences detected in the liver effects of buprenorphine vs. methadone No clear evidence of any serious liver injury from either medication Hepatitis and ongoing illicit drug use look like the main drivers of worsening indices of liver health in opioid dependent population Continued
SECONDARY STUDY OBJECTIVES The objective of this secondary analysis was to explore differences in baseline clinical characteristics and opioid replacement therapy treatment outcomes by type (heroin, opioid analgesic [OA], or combined [heroin and OA]) and route (injector or non-injector) of opioid use.
Results
Results
Results
Results
Results
Treatment interactions No significant two-way interactions between treatment assignment and opioid type or treatment assignment and injection status on attrition. In other words, there were similar factors influencing rates of attrition for those on buprenorphine and those on methadone concerning type of opioid used or injection status.
RESULTS Summary
OA Users vs. Heroin Users OA users are more likely to be: Younger 1 Female 1 White 1 Employed and to report pain 1 OA users also have: Fewer attempts at treatment for substance use disorder 2 Fewer years of opioid use 2 Less drug-related medical complications than heroin users 2 Overall, OA users tend to present with a less severe opioid dependence compared with heroin users 1 Rosenblum et al., 2007 2 Moore et al., 2007
OA Users vs. Heroin Users Heroin users are more likely to: Be older, African American 1 Have a history of attempts at treatment for substance use disorder 1 Report using other drugs 1 Be involved with the legal system 2 Have a history of injecting opioids and sharing needles 3 Heroin use is often associated with a longer drug-using history compared with OA use 1 Wu et al., 2011 Continued 2 Banta-Green et al., 2009 3 Brands et al., 2004
Combined Users (OA and heroin) Report more polydrug use Are more likely to have multiple substance use disorder diagnoses- including a lifetime opioid use disorder diagnosis 1 Vs. heroin users are more likely to be: White 2 Vs. OA users are more likely to: Have more attempts at treatment for substance use disorder 2 Continued 1 Wu et al., 2011 2 Moore et al., 2007
Heroin Injectors vs. Non-injectors Non-injectors: More likely to be female 1, younger and employed 2 Have higher levels of education 2 Lower levels of crime 2 Shorter heroin-using histories 2 Fewer symptoms of dependence 2 Fewer attempts at treatment for substance use disorder 2 Fewer overdoses 2 Overall, more stable socioeconomic status and fewer adverse effects 1 Puigdollers et al., 2004 2 Darke et al., 2004
Heroin Injectors vs. Non-injectors Heroin injectors: More likely to be homeless 1 Unemployed 1 Long-time users 1 Younger at first heroin use, and 1 Initiated heroin use through intravenous routes 1 More likely to report a history of incarceration and arrests 2 1 Neaigus et al., 2001 2 Young and Havens, 2012
Summary Differences in clinical characteristics of individuals with opioid dependence vary by: Type of Opioid Used Opioid analgesic [OA] Heroin Route of Use Oral Intravenous