Non heroin-using prescription opioid users respond well to opioid substitution treatment
September 2014
Citation:
Nielsen, S., Hillhouse, M., Mooney, L., Ang, A., & Ling, W. (2014). Buprenorphine pharmacotherapy and behavioural treatment: comparison of outcomes among prescription opioid users, heroin users and combination users. Journal of Substance Abuse Treatment, Advance online publication. DOI: 10.1016/j.jsat.2014.06.006.
The increasing population of prescription opioid (PO) users in the United States and elsewhere including Australia is well documented. There has been a growing demand for treatment for PO dependence, and the high mortality associated with PO dependence suggests an urgent need for empirical research to identify effective treatments.
Most research examining buprenorphine has been conducted with heroin users. In this paper the authors compared outcomes of buprenorphine pharmacotherapy and behavioural treatment among heroin users, PO users and combination users.
The authors analysed data from a randomised controlled trial of behavioural treatment provided for 16 weeks on a platform of buprenorphine pharmacotherapy and medication management. They compared 54 heroin users, 54 PO users and 71 combination heroin and PO users to test the hypothesis that PO users will have better treatment outcomes compared with heroin users. The PO group provided more opioid-negative urine drug screens over the combined treatment period and at the end of the combined treatment period. Retention was lowest in the heroin group. There was no significant difference in buprenorphine dose between the groups. PO users appear to have better outcomes in buprenorphine pharmacotherapy compared to those reporting any heroin use, confirming that buprenorphine pharmacotherapy is effective in PO users.
Consistent with findings from previous research, it appears that PO users who do not also use heroin have favourable treatment outcomes with both buprenorphine and methadone treatment. These combined findings suggest that treatment protocols that were developed based on evidence from studies with heroin users may also be appropriate for PO users. Further research may be needed to identify if there are groups of PO users who do not do well in treatment. Also, given the promising treatment outcomes, future efforts to make treatment more accessible to all PO users appears to be a critical strategy for reducing the currently high mortality rates in young people from PO overdoses.
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