Buprenorphine/naloxone and methadone effectiveness for reducing craving in individuals with prescription opioid use disorder: Exploratory results from an open-label, pragmatic randomized controlled trial

McAnulty, Christina; Bastien, Gabriel; Socías, M. Eugenia; Bruneau, Julie; Foll, Bernard Le; Lim, Ron; Brissette, Suzanne; Ledjiar, Omar; Marsan, Stéphanie; Talbot, Annie; Jutras‐Aswad, Didier

doi:10.1016/j.drugalcdep.2022.109604

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…It is possible that those who had witnessed more overdoses were less likely to have recently used pain medication out of concern for the high risk of overdose when using street-acquired pain medications that contain fentanyl [60,61] as well as an inability to access genuine opioid pain medication via a doctor or on the street [56,62]. Notably, in alignment with the literature [63][64][65], several participants reported that buprenorphine was effective in helping participants to manage opioid cravings as well as pain, which may also explain the lower prevalence of pain medication use as opposed to the use of other drugs among the people who use drugs who were sampled.…”

Section: Discussionmentioning

confidence: 90%

“…The prevalent concurrent use of illegal drugs and MOUD among this sample, the potential for administrative discharge from outpatient programs for people concurrently using illegal drugs and MOUD, and research linking MOUD use to reduced opioid fatality risk [14,15,17] underscore the need for a paradigm shift from the rigid "no tolerance" MOUD prescribing practices of the past to a more harm reduction-focused model that recognizes that recovery is a continuum. To that end, research in Canada and the US finds that flexible MOUD treatment models that allow for take-home dosing of methadone and buprenorphine-naltrexone are feasible, acceptable, safe, effective, and, in some cases, associated with better treatment outcomes than standard models of care [63,[80][81][82]. In addition to providing more flexibility, expanded treatment models should also account for the impact of trauma on drug use behaviors and use a trauma-informed approach to treatment [44] that leverages and seeks to build internal and external patient resources [83] such as distress tolerance [84,85] and social support [86] to reduce ongoing drug use and help patients achieve their recovery goals.…”

Section: Discussionmentioning

confidence: 99%

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Drug use patterns and factors related to the use and discontinuation of medications for opioid use disorder in the age of fentanyl: findings from a mixed-methods study of people who use drugs

Hughto

Tapper

Rapisarda

et al. 2023

Subst Abuse Treat Prev Policy

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Background Medications for opioid use disorder (MOUD; methadone, buprenorphine, naltrexone) are the most effective treatments for OUD, and MOUD is protective against fatal overdoses. However, continued illegal drug use can increase the risk of treatment discontinuation. Given the widespread presence of fentanyl in the drug supply, research is needed to understand who is at greatest risk for concurrent MOUD and drug use and the contexts shaping use and treatment discontinuation. Methods From 2017 to 2020, Massachusetts residents with past-30-day illegal drug use completed surveys (N = 284) and interviews (N = 99) about MOUD and drug use. An age-adjusted multinomial logistic regression model tested associations between past-30-day drug use and MOUD use (current/past/never). Among those on methadone or buprenorphine (N = 108), multivariable logistic regression models examined the association between socio-demographics, MOUD type; and past-30-day use of heroin/fentanyl; crack; benzodiazepines; and pain medications. Qualitative interviews explored drivers of concurrent drug and MOUD use. Results Most (79.9%) participants had used MOUD (38.7% currently; 41.2% past), and past 30-day drug use was high: 74.4% heroin/fentanyl; 51.4% crack cocaine; 31.3% benzodiazepines, and 18% pain medications. In exploring drug use by MOUD history, multinomial regression analyses found that crack use was positively associated with past and current MOUD use (outcome referent: never used MOUD); whereas benzodiazepine use was not associated with past MOUD use but was positively associated with current use. Conversely, pain medication use was associated with reduced odds of past and current MOUD use. Among those on methadone or buprenorphine, separate multivariable logistic regression models found that benzodiazepine and methadone use were positively associated with heroin/fentanyl use; living in a medium-sized city and sex work were positively associated with crack use; heroin/fentanyl use was positively associated with benzodiazepine use; and witnessing an overdose was inversely associated with pain medication use. Many participants qualitatively reported reducing illegal opioid use while on MOUD, yet inadequate dosage, trauma, psychological cravings, and environmental triggers drove their continued drug use, which increased their risk of treatment discontinuation and overdose. Conclusions Findings highlight variations in continued drug use by MOUD use history, reasons for concurrent use, and implications for MOUD treatment delivery and continuity.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Drug use patterns and factors related to the use and discontinuation of medications for opioid use disorder in the age of fentanyl: findings from a mixed-methods study of people who use drugs

Hughto

Tapper

Rapisarda

et al. 2023

Subst Abuse Treat Prev Policy

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“…Again, this moderation effect was detected among individuals who use heroin and does not seem to apply in POUD population. 26 The differential effect of OAT used in OPTIMA in terms of reduced opioid use may also be explained in part by reduced opioid craving, 33 which may not be affected by non-opioid substance use when related to highly potent opioid exposure. Overall, non-opioid substance use seemed to play a limited role in treatment-related outcomes in POUD in our study.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Buprenorphine\Naloxone and Methadone Treatment and non-Opioid Substance Use in Prescription-Type Opioid Use Disorder: Secondary Analyses From the OPTIMA Study: Associations entre le traitement avec la buprénorphine/naloxone et avec la méthadone et l'utilisation de substances non opioïdes dans le trouble lié à l'usage d'opioïdes de type sur ordonnance : analyses secondaires de l'étude OPTIMA

Bakouni,

Sharafi,

Drouin

et al. 2023

Can J Psychiatry

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Objectives There is limited evidence on how opioid agonist treatment (OAT) may affect psychoactive non-opioid substance use in prescription-type opioid use disorder (POUD) and whether this effect might explain OAT outcomes. We aimed to assess the effect of methadone on non-opioid substance use compared to buprenorphine/naloxone (BUP/NX), to explore whether non-opioid substance use is associated with opioid use and retention in treatment, and to test non-opioid use as a moderator of associations between methadone with retention in OAT and opioid use compared to BUP/NX. Methods This is a secondary analysis of data from the OPTIMA trial, an open-label, pragmatic, parallel, two-arm, pan-Canadian, multicentre, randomized-controlled trial to compare standard methadone model of care and flexible take-home dosing BUP/NX for POUD treatment. We studied the effect of methadone and BUP/NX on non-opioid substance use evaluated by urine drug screen (UDS) and by classes of non-opioid substances (i.e., tetrahydrocannabinol [THC], benzodiazepines, stimulants) (weeks 2–24) using adjusted generalized estimation equation (GEE). We studied the association between non-opioid substance-positive UDS and opioid-positive UDS and retention in treatment, using adjusted GEE and logistic regressions. Results Overall, methadone was not associated with non-opioid substance-positive UDS compared to BUP/NX (OR: 0.78; 95%CI, 0.41 to 1.48). When non-opioid substances were studied separately, methadone was associated with lower odds of benzodiazepine-positive UDS (OR: 0.63; 95% CI: 0.40 to 0.98) and THC-positive UDS (OR: 0.47; 95% CI: 0.28 to 0.77), but not with different odds of stimulant-positive UDS (OR: 1.29; 95% CI: 0.78 to 2.16) compared to BUP/NX. Substance-positive UDS, overall and separate classes, were not associated with opioid-positive UDS or retention in treatment. Conclusion Methadone did not show a significant effect on overall non-opioid substance use in POUD compared to BUP/NX treatment but was associated with lower odds of benzodiazepine and THC use in particular. Non-opioid substance use did not predict OAT outcomes. Further research is needed to ascertain whether specific patterns of polysubstance use (quantity and frequency) may affect treatment outcomes.

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“…Another report showed that both treatment arms decreased craving frequency, length, and intensity at a similar rate. 37 Both methadone and BUP/NX can also lower withdrawal symptoms, which are associated with increased anxiety and dysphoric moods. 38 , 39 Therefore, by reducing cravings and withdrawal symptoms, both OATs could have reduced anxiety and depressive states, leading to improvements in overall well-being.…”

Section: Discussionmentioning

confidence: 99%

Effects of Buprenorphine/Naloxone and Methadone on Depressive Symptoms in People with Prescription Opioid Use Disorder: A Pragmatic Randomised Controlled Trial

et al. 2022

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Objective This study aimed to evaluate the effectiveness of flexible take-home dosing of buprenorphine/naloxone (BUP/NX) and methadone standard model of care in reducing depressive symptoms in people with prescription-type opioid use disorder (POUD). This trial also evaluated whether improvements in depressive symptoms were mediated by opioid use. Methods Analyzed data came from the OPTIMA study (clinicaltrials.gov identifier: NCT03033732), a pragmatic randomised controlled trial comparing flexible take-home dosing of BUP/NX and methadone standard model of care for reducing opioid use in people with POUD. A total of 272 participants were recruited in four Canadian provinces. Participants were randomised 1:1 to BUP/NX or methadone. After treatment induction, past two-week opioid use was measured using the Timeline Followback every two weeks for a total of 24 weeks. Depressive symptoms were measured with the Beck Depression Inventory at baseline, weeks 12 and 24. Results Both BUP/NX and methadone significantly reduced depressive symptoms at week 12 (aβ ± SE = −3.167 ± 1.233; P < 0.001) and week 24 (aβ ± SE = −7.280 ± 1.285; P < 0.001), with no interaction between type of treatment and time ( P = 0.284). Improvements in depressive symptoms were only partially mediated by a reduction in opioid use (proportion mediated = 36.8%; 95% confidence interval = −1.158 to −0.070; P = 0.015). Conclusions BUP/NX and methadone showed similar effectiveness in decreasing comorbid depressive symptoms in people with POUD. This effect was partially explained by a reduction in opioid use. As both treatments seem equally effective, clinicians are encouraged to tailor the selection of OAT to patients’ needs and characteristics.

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Buprenorphine/naloxone and methadone effectiveness for reducing craving in individuals with prescription opioid use disorder: Exploratory results from an open-label, pragmatic randomized controlled trial

Cited by 6 publications

References 20 publications

Drug use patterns and factors related to the use and discontinuation of medications for opioid use disorder in the age of fentanyl: findings from a mixed-methods study of people who use drugs

Drug use patterns and factors related to the use and discontinuation of medications for opioid use disorder in the age of fentanyl: findings from a mixed-methods study of people who use drugs

Effects of Buprenorphine/Naloxone and Methadone on Depressive Symptoms in People with Prescription Opioid Use Disorder: A Pragmatic Randomised Controlled Trial

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