Correlates of Long-Term Opioid Abstinence After Randomization to Methadone Versus Buprenorphine/Naloxone in a Multi-Site Trial
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Opioid use disorder (OUD) is a chronic, relapsing condition with severe negative health consequences. Previous studies have reported that 5-year opioid abstinence is a good predictor of reduced likelihoods of relapse, but factors that shape long-term opioid abstinence are poorly understood. The present study is based on data from a prospective study of 699 adults with OUD who had been randomized to either methadone or buprenorphine/naloxone and who were followed for at least 5 years. During the 5 years prior to the participants’ last follow-up interview, 232 (33.2%) had achieved 5-year abstinence from heroin. Of those 232, 145 (20.7% of the total) had remained abstinent from both heroin and other opioids (e.g., hydrocodone, oxycodone, other opioid analgesics, excluding methadone or buprenorphine). Compared to non-abstinent individuals, those in both categories of opioid abstinence had lower problem severity in health and social functioning at the final follow-up. Logistic regression results indicated that cocaine users and injection drug users were less likely to achieve 5-year heroin abstinence, whereas Hispanics (vs. whites) and those treated in clinics on the West Coast (vs. East) were less likely to achieve 5-year abstinence from heroin and other opioids. For both abstinence category groups, abstinence was positively associated with older age at first opioid use, lower impulsivity, longer duration of treatment for OUD, and greater social support. Reducing cocaine use and injection drug use and increasing social support and retention in treatment may help maintain long-term abstinence from opioids among individuals treated with agonist pharmacotherapy.
KeywordsOpioid use disorder Pharmacotherapy Buprenorphine Naloxone Methadone
Sincere appreciation to our participating networks: the Pacific Northwest Node of the Clinical Trials Network (CTN) and Evergreen Treatment Services; the CTN Western States Node and CODA Inc. and Bi-Valley Medical Clinic; the CTN New England Node and Connecticut Counseling Centers and Yale and Hartford Dispensary; the CTN Delaware Valley Node and NET Steps; the CTN Pacific Region Node and Matrix Institute; EMMES Corporation (the CTN Coordinating Center); the CCTN and NIDA.
Main study funding was provided by the National Institute on Drug Abuse (NIDA) through the Clinical Trials Network (CTN) through a series of grants provided to each participating CTN node: The Pacific Northwest Node (U10 DA01714); The Western States Node (U10 DA 015815); The New England Node (U10 DA13038); The Delaware Valley Node (U10 DA13043); The Pacific Region Node (U10 DA13045); The Greater New York Node (UG1 DA013035).
Compliance with Ethical Standards
Conflict of Interest
Authors disclosing relevant financial interests, activities, relationships, and affiliations are: Andrew J. Saxon: receives royalties as a section editor for UpToDate. All other authors report no financial or other possible conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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