Predictors of buprenorphine initial outpatient maintenance and dose taper response among non-treatment-seeking heroin dependent volunteers

Abstract

Background 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. Methods 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). Results 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 vs. 8 days to opioid-lapse) and nearly half (46.7%) refrained from opioid use during dose taper. Conclusions 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.

Predictors of Relapse after Inpatient Opioid Detoxification during 1-Year Follow-Up

“…(2) Greater amount of heroin use, longer duration, history of injecting, and >3 lifetime heroin-quit attempts have been found to be significant predictors of relapse [ 3 , 12 ]. Our study corroborates all these findings.…”

Heroin delay discounting: Modulation by pharmacological state, drug-use impulsivity, and intelligence.

“…Comprehensive lifetime and current substance use were assessed via a standardized self-report battery (Drug History and Use Questionnaire; available upon request). Variables characterized in the present study included age at heroin-use onset, age at intensive heroin use (≥3 times weekly), route of administration (injection/noninjection), years of heroin use (age at screening minus age at initial use), treatment sought for heroin use (ever/never), number of heroin-quit attempts (range: 0–100), total number of heroin use–related negative consequences (21 items; e.g., heroin overdose and work problems related to heroin use, each ever/never; see Woodcock, Lundahl, & Greenwald, 2015), and total past-month heroin use (product score: mean number of daily heroin uses in the past week multiplied by number of days using in the past month; maximum = 30 days).…”

“…Estimated intelligence. The Shipley Institute of Living Scale (Zachary, 1991) Greenwald, 2015), and total past-month heroin use (product score: mean number of daily heroin uses in the past week multiplied by number of days using in the past month; maximum ϭ 30 days).…”

Tapering off and returning to buprenorphine maintenance in a primary care Office Based Addiction Treatment (OBAT) program

“…Despite the fact that many patients desire to taper off buprenorphine (Teruya et al, 2014; Woodcock et al, 2015), a small minority (an estimated 15%) had a documented taper among this large sample of patients over a 12 year period. This rate was similar (14%) even among the subgroup of patients who were in care for at least six months and may have been more likely to successfully complete a taper.…”