PMID- 26400835
OWN - NLM
STAT- MEDLINE
DCOM- 20160516
LR  - 20181202
IS  - 1521-0391 (Electronic)
IS  - 1055-0496 (Print)
IS  - 1055-0496 (Linking)
VI  - 24
IP  - 7
DP  - 2015 Oct
TI  - Treatment outcomes in opioid dependent patients with different 
      buprenorphine/naloxone induction dosing patterns and trajectories.
PG  - 667-75
LID - 10.1111/ajad.12288 [doi]
AB  - BACKGROUND AND OBJECTIVES: Induction is a crucial period of opioid addiction 
      treatment. This study aimed to identify buprenorphine/naloxone (BUP) induction 
      patterns and examine their association with outcomes (opioid use, retention, and 
      related adverse events [AEs]). METHODS: The secondary analysis of a study of 
      opioid-dependent adults seeking treatment in eight treatment settings included 
      740 participants inducted on BUP with flexible dosing. RESULTS: Latent class 
      analysis models detected six distinctive induction trajectories: bup1-started and 
      remained on low; bup2-started low, shifted slowly to moderate; bup3-started low, 
      shifted quickly to moderate; bup4-started high, shifted to low; bup5-started and 
      remained on moderate; bup6-started moderate, shifted to high dose (Fig. 1). 
      Baseline characteristics, including Clinical Opioid Withdrawal Scale (COWS), were 
      important predictors of retention. When controlled for the baseline 
      characteristics, bup6 participants were three times less likely to drop out the 
      first 7 days than bup1 participants (adjusted hazard ratio (aHR) = .28, p = .03). 
      Opioid use and AEs were similar across trajectories. Participants on >/=16 mg BUP 
      compared to those on <16 mg at Day 28 were less likely to drop out (aHR = .013, 
      p = .001) and less likely to have AEs during the first 28 days (aOR = .57, 
      p = .03). DISCUSSION AND CONCLUSIONS: BUP induction dosing was guided by an 
      objective measure of opioid withdrawal. Participants with higher baseline COWS 
      whose BUP doses were raised more quickly were less likely to drop out in the 
      first 7 days than those whose doses were raised slower. SCIENTIFIC SIGNIFICANCE: 
      This study supports the use of an objective measure of opioid withdrawal (COWS) 
      during BUP induction to improve retention early in treatment.
CI  - (c) American Academy of Addiction Psychiatry.
FAU - Jacobs, Petra
AU  - Jacobs P
AD  - The EMMES Corporation, Rockville, Maryland.
FAU - Ang, Alfonso
AU  - Ang A
AD  - UCLA, Los Angeles, California.
FAU - Hillhouse, Maureen P
AU  - Hillhouse MP
AD  - UCLA, Los Angeles, California.
FAU - Saxon, Andrew J
AU  - Saxon AJ
AD  - VA Puget Sound Health Care, Seattle, Washington.
FAU - Nielsen, Suzanne
AU  - Nielsen S
AD  - University of New South Wales, National Drug and Alcohol Research Centre, Sydney, 
      Australia.
FAU - Wakim, Paul G
AU  - Wakim PG
AD  - NIDA Center for the Clinical Trials Network, Rockville, Maryland.
FAU - Mai, Barbara E
AU  - Mai BE
AD  - The Uniformed Services University of the Health Sciences, Bethesda, Maryland.
FAU - Mooney, Larissa J
AU  - Mooney LJ
AD  - UCLA, Los Angeles, California.
FAU - S Potter, Jennifer
AU  - S Potter J
AD  - University of Texas Health Science Center, San Antonio, Texas.
FAU - Blaine, Jack D
AU  - Blaine JD
AD  - The EMMES Corporation, Rockville, Maryland.
LA  - eng
GR  - U10 DA013714/DA/NIDA NIH HHS/United States
GR  - 5 U10 DA013714-08/DA/NIDA NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
DEP - 20150924
PL  - England
TA  - Am J Addict
JT  - The American journal on addictions
JID - 9208821
RN  - 0 (Buprenorphine, Naloxone Drug Combination)
RN  - 0 (Narcotic Antagonists)
SB  - IM
MH  - Adult
MH  - Buprenorphine, Naloxone Drug Combination/*administration & dosage/adverse 
      effects/*therapeutic use
MH  - Drug Administration Schedule
MH  - Female
MH  - Humans
MH  - Male
MH  - Narcotic Antagonists/*administration & dosage/adverse effects/*therapeutic use
MH  - Opioid-Related Disorders/*drug therapy
MH  - Patient Dropouts/statistics & numerical data
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC5322942
MID - NIHMS849614
EDAT- 2015/09/25 06:00
MHDA- 2016/05/18 06:00
PMCR- 2017/02/23
CRDT- 2015/09/25 06:00
PHST- 2015/03/30 00:00 [received]
PHST- 2015/07/24 00:00 [revised]
PHST- 2015/08/17 00:00 [accepted]
PHST- 2015/09/25 06:00 [entrez]
PHST- 2015/09/25 06:00 [pubmed]
PHST- 2016/05/18 06:00 [medline]
PHST- 2017/02/23 00:00 [pmc-release]
AID - 10.1111/ajad.12288 [doi]
PST - ppublish
SO  - Am J Addict. 2015 Oct;24(7):667-75. doi: 10.1111/ajad.12288. Epub 2015 Sep 24.