NIDA Study Reveals Distinct Reasons for Individualized Opioid Addiction Treatment

By John Lavitt 02/24/15

The NIDA-supported clinical trial on opioid addiction found some surprising results.

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On February 18, the National Institute on Drug Abuse reported on the findings of NIDA-supported clinical trial on opioid addiction.

Carried out by a team at the University of Texas Health Science Center at San Antonio led by Dr. Jennifer S. Potter, the study examined the result of work with 1,289 START participants over the course of 24 weeks of treatment. The data from the Starting Treatment with Agonist Replacement Therapies (START) trial pointed towards a need for individualized therapy for opioid addiction.

While one common supposition about treatment for opioid addiction was affirmed by the study, another was unquestionably challenged. As expected, trial participants who were addicted to opioid painkillers and did not inject drugs stayed in treatment longer and achieved better outcomes when compared to participants who were addicted to heroin or other injected drugs.

In contrast to these expected findings, the current supposition that users of painkillers would benefit more from buprenorphine/naloxone (Bp/Nx) therapy than from methadone turned out to be affected negatively by both the setting of the treatment and the individualized experience of each participant.

Noting the success of the study, Dr. Will Aklin, NIDA Program Officer in the Behavioral and Integrative Treatment Branch, said, “Dr. Potter’s study shows that clinicians can use information based on clinical baseline characteristics to tailor treatment plans to a patient’s specific needs…In particular, the study suggests that the type of opiate primarily used and injection status are factors to be considered when determining what sort of treatment is most likely to retain a patient in treatment and prevent relapse.”

Altogether, 731 patients completed the full 24-week course of treatment, but those assigned to take Bp/Nx were 60% more likely to drop out. The results seem to reflect the setting of the treatments. Run in nine methadone programs, many of the participants had undergone treatment with methadone before the trial. Some reported they had felt better on methadone when compared to the Bp/Nx and more complained about the latter.

Given the recent popularity of buprenorphine over methadone, such findings will be surprising to most treatment professionals. In contrast, the study’s findings that the participants who used only painkillers had a higher rate of treatment completion than those who used only heroin (70% vs. 56%) is not surprising. Injectors were roughly twice as likely as non-injectors to have relapsed by the end of treatment. Such findings confirm the traditional perspective that both illegal drug abuse and injectable drug abuse are markers for severe addiction. On average, the heroin users were older than those who used painkillers, suggesting longer drug careers.

Dr. Potter hopes the findings of the study will help clinicians make optimal treatment choices for individual patients. Dr. Potter elucidated the need for individualized therapy as demonstrated by the study: “People who inject drugs or use heroin may need more structured attention and a higher level of monitoring during treatment, because they have an increased risk for dropping out. When treating users of opioid painkillers, physicians should feel confident recommending either buprenorphine or methadone, depending on the medications’ availability and patients’ preference.”

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Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles with his beautiful wife, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.

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