Worries About Discontinuing Buprenorphine Treatment: Scale Development and Clinical Correlates

Abstract

Background and Objectives: Despite the benefits of maintenance buprenorphine treatment for opioid use disorder (OUD), many individuals report an interest in discontinuing the medication, while also expressing worries about tapering. The purpose of this study was to develop a measure of worries about buprenorphine discontinuation ("Off Bupe") and determine the demographic and clinical characteristics associated with these worries. Methods: Between May 2017 and May 2018, we surveyed adults in an outpatient primary care buprenorphine program (n=138). Reliability and validity of the Off Bupe measure were examined. Results: Participants averaged 39 years of age, 54% were male, average duration of buprenorphine was 189 weeks and 85.5% reported eventually wanting to discontinue buprenorphine, although fewer than 10% were actively tapering. We derived two scales, withdrawal symptom worry (10 items, alpha= .94) and relapse worry (7 items, alpha= .88). Worry about symptoms was positively associated with current buprenorphine dose (p = .016), physical discomfort avoidance (p < .001), and inversely associated with self-efficacy to quit buprenorphine (p < .001) and distress tolerance (p < .001). Worry about opioid relapse was associated positively with age (p = .019), current buprenorphine dose (p = .004), physical discomfort avoidance (p <. 001) and impulsivity (p = .002), and inversely associated with self-efficacy to quit buprenorphine (p < .001). Discussion and Conclusions: Psychometric evaluation of the "Off Bupe" scale demonstrated its content and construct validity, and internal reliability. Scientific Significance: The scale might help individuals with OUD and their providers identify concerns about discontinuing buprenorphine.

Cues conditioned to withdrawal and negative reinforcement: Neglected but key motivational elements driving opioid addiction

“…In one study of patients with OUD enrolled in buprenorphine maintenance therapy, 89.9% of the participants reported that concerns about withdrawal were a primary reason for continuing treatment ( 37 ). In addition, the degree of concern about stopping buprenorphine maintenance was positively correlated with self-reported desire to avoid physical discomfort ( 35 ). Therefore, in human patients with OUD, fear of anticipated withdrawal symptoms and the desire to escape somatic and emotional discomfort are major motivational factors that drive continued opioid use.…”

“…Several studies have reported in human patients with OUD that avoiding the onset of withdrawal symptoms is a major motivation for continuing opioid use (i.e., conditioned negative reinforcement) (2,33). For patients with OUD undergoing opioid substitution treatment with buprenorphine or methadone, withdrawal discomfort and greater pain were major concerns when choosing to taper off treatment (34)(35)(36). In one study of patients with OUD enrolled in buprenorphine maintenance therapy, 89.9% of the participants reported that concerns about withdrawal were a primary reason for continuing treatment (37).…”

Classics in Chemical Neuroscience: Buprenorphine

“…Most saliently, although the risk is diminished as compared to full opioid agonists, buprenorphine still carries with it the class-wide risk for fatal respiratory depression upon overdose, alone and in combination with other CNS depressants . Furthermore, the optimal approach for treatment of acute pain in the context of chronic buprenorphine therapy for OUD remains an area of active concern and debate. , Similarly, patients, providers, and payers have widely divergent opinions on the desirability of lifetime treatment with buprenorphine, highlighting ongoing tensions regarding indefinite use of MAT for OUD. − …”

Kann die Symptombelastung einen regulären oder irregulären Behandlungsabschluss bei Substanzkonsumstörungen vorhersagen?

“…Zudem angeregt werden könnte, die BSCL (oder vergleichbare Instrumente) routinemäßig in (teil-) stationären Settings dafür einzusetzen. Dabei sollten tatsächlich vorhandene symptomatische Beschwerden von möglichen Sorgen über gegebenenfalls auftretende Symptome differenziert werden [35].…”