NIDA Grants: U10DA015831, K24DA022288, U10DA020024, K23DA022297, U10DA013045 Predictors of Outcome in the Multi-Site CTN Prescription Opioid Addiction.

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NIDA Grants: U10DA015831, K24DA022288, U10DA020024, K23DA022297, U10DA Predictors of Outcome in the Multi-Site CTN Prescription Opioid Addiction Treatment Study R Weiss 1, J Potter 1,2 M Griffin 1, H Connery 1, W Ling 3 1 McLean Hospital Division of Alcohol and Drug Abuse & Harvard Medical School, 2 University of Texas Health Science Center, 3 UCLA Predictors of Outcome in the Multi-Site CTN Prescription Opioid Addiction Treatment Study R Weiss 1, J Potter 1,2 M Griffin 1, H Connery 1, W Ling 3 1 McLean Hospital Division of Alcohol and Drug Abuse & Harvard Medical School, 2 University of Texas Health Science Center, 3 UCLA Abstract Sample Characteristics POATS Study Design Key eligibility criteria  DSM-IV opioid dependence, with physical dependence  ≤4 days of heroin use in past 30 days  No history of heroin injection Sociodemographic  Female42%  White 91%  Education, years (mean, sd) 12.9, 2.2  Employed full time 60% Clinical  Lifetime heroin use 26%  Current chronic pain 41%  Duration of opioid use (median) 2-4 years Findings AIM To examine baseline predictors of outcome for prescription opioid dependent patients treated with buprenorphine/naloxone for 12 weeks (phase 2) METHOD Interviews and self-administered questionnaires were used to collect data on sociodemographic and clinical characteristics in a 2- phase randomized medication+ counseling trial. RESULTS Successful outcomes were more likely among those who had no prior treatment for opioid use disorder (including attending self-help meetings), had never used a route other than that prescribed, did not use primarily sustained-release oxycodone, had lifetime depression, whose first source of opioids was a legitimate medical prescription, who first used to relieve physical pain, and were older. CONCLUSION Among patients with prescription opioid dependence, characteristics traditionally associated with opioid addiction were associated with poorer outcomes. Successful outcomes associated with  Older age  Lifetime history of depression  No prior treatment for opioid use disorder  Route of use is oral or sublingual only Conclusions Successful Outcomes Definition of Phase 1 success (at week 12)  ≤4 days/month of opioid use  Absence of 2 consecutive opioid-positive urine tests  ≤1 missing urine sample during 12 weeks  No other substance use disorder treatment (other than self-help) Definition of Phase 2 success (at weeks 12 and 24)  Abstinent for final week by urine-confirmed self-report  Abstinent ≥2 of the 3 previous weeks Findings for rates of successful outcomes  Phase 1, week %  Phase 2, week 12, end of treatment 49.2%  Phase 2, week 24, end of taper 8.6% Weiss et al., Archives of General Psychiatry, in press Final logistic regression model to predict success (N=360) Baseline characteristicsOdds ratio95% CIs Age + 10 years1.28* Lifetime depression1.83* Prior opioid use disorder treatment.62* Non-recommended route of use.51 ^ Model R 2 9.7%** ^ p=.052 *p<.05 **p<.01 Other significant predictors by outcome Patient characteristics Successful (n=177) Not (n=183) Age, mean (sd)**33.9 (10.0)31.2 (9.1) 1 st source of opioids* Medical Rx 62%49% Dealer 6%14% 1 st reason to use opioids* For pain 70%60% To get high 24%33% *p<.05 **p<.01