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A Comparison of Buprenorphine Taper Outcomes Between Prescription Opioid and Heroin Users

Nielsen, Suzanne PhD; Hillhouse, Maureen PhD; Thomas, Christie MPH; Hasson, Albert MSW; Ling, Walter MD

doi: 10.1097/ADM.0b013e318277e92e
Original Research

Objectives: Dependence on prescription opioids (PO) is a growing problem. Although most research with buprenorphine has focused on heroin-dependent populations, we hypothesize that individuals dependent on PO display characteristics that may predict different outcomes in treatment, particularly in short-term taper procedures in which comorbidities such as pain conditions may complicate taper.

Methods: This secondary data analysis examined differences in outcomes between PO users (n = 90) and heroin users (n = 426) after a buprenorphine taper. Data were collected in a multisite randomized clinical trial conducted by the National Drug Abuse Treatment Clinical Trials Network at 11 study sites across the United States. After a 4-week buprenorphine induction/stabilization phase, 516 opioid-dependent individuals were randomized into 1 of 2 taper lengths (7 vs 28 days) to assess the association between taper length and outcome. The primary outcome was measured by urine drug test for opioids at the end of the taper period. Craving, withdrawal, and buprenorphine dose were also examined.

Results: After controlling for baseline demographic and drug use differences between the opioid use groups, results indicate that a higher percentage of the PO group (49%) provided an opioid-free urine drug specimen at the end of taper compared with the heroin group (36%; χ21 = 6.592, P < 0.010).

Conclusion: Short-term taper is not recommended as a stand-alone treatment; however, patients may taper from buprenorphine as part of a treatment plan. Despite greater comorbidity, PO users seem to have favorable taper outcomes compared with heroin users. Further studies are required to examine longer-term treatment outcomes.

From the UCLA Integrated Substance Abuse Programs, Los Angeles, California (SN, MH, CT, AH and WL); and University of Sydney, Sydney, New South Wales, Australia (SN).

Send correspondence and reprint requests to Suzanne Nielsen, PhD, Drug Health Services, Level 6, KGV Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, New South Wales, Australia. E-mail: Suzanne.Nielsen@sydney.edu.au.

Supported by the National Institute on Drug Abuse Clinical Trials Network #U10 DA 13045; the first author (S.N.) received a NIDA INVEST Clinical Trials Network Fellowship and is currently the recipient of an NHMRC Clinical Research Training Fellowship.

S.N. has also previously worked on unrestricted education grants from Reckitt-Benckiser that are not related to this work. W.L. has received unrestricted education grants from Reckitt-Benckiser and research support from Reckitt/Benckiser and Hythiam Inc, and has also served as an occasional consultant to Reckitt/Benckiser, Titan Pharmaceuticals, US World Med Inc, Alkermes, and DemeRx. M.T. has in the past participated in the Reckitt/Benkiser “Treatment Advocate” program. The other authors declare no conflicts of interest.

Clinicaltrials.gov Identifier: NCT00078117

Received February 22, 2012

Accepted October 6, 2012

© 2013 American Society of Addiction Medicine