Prior studies have suggested that buprenorphine plus medical management can be an effective treatment for individuals with prescription opioid use disorder, and that these patients may have more favorable outcomes with buprenorphine treatment than those with heroin use. This secondary data analysis compared treatment outcomes among 179 individuals with either prescription opioid (PO), heroin (H), or combined prescription opioid and heroin (POH) use disorder, drawing on data from a 16-week randomized clinical trial studying four different behavioral treatments coupled with buprenorphine and standard medical management. A subsequent 16-week buprenorphine-only phase followed. Follow-up was performed at weeks 40 and 52.
At study entry, the PO-only patients were more likely to be white, married, employed in the last 30 days, and to have shorter duration of opioid use than those in the other two groups.
The PO group provided more opioid-negative urine drug screens throughout treatment (PO: 70%, H: 38%, POH: 40%), and at the end of treatment (PO: 65%, H: 33%, POH: 31%).
Retention was lowest in the heroin group (PO: 80%, H: 57%, POH: 65%).
There were no significant differences in buprenorphine dose across the groups.
The authors concluded that those patients with prescription opioid use disorder had more favorable buprenorphine treatment outcomes than individuals with heroin or combined prescription opioid and heroin use disorder. However, differences in baseline characteristics between the three groups may explain some of the outcomes as the PO group had more social support at treatment outset.
Nielsen S, Hillhouse M, Mooney L, et al. Buprenorphine pharmacotherapy and behavioral treatment: comparison of outcomes among prescription opioid users, heroin users and combination users. J Subst Abuse Treat. 2015;48:70–76.
Source: Alcohol, Other Drugs, and Health: Current Evidence – January–February 2015, Jeanette M. Tetrault, MD