The Prescription Opioid Addiction Treatment Study: What have we learned

Abstract

Background: The multi-site Prescription Opioid Addiction Treatment Study (POATS), conducted by the National Drug Abuse Treatment Clinical Trials Network, was the largest clinical trial yet conducted with patients dependent upon prescription opioids (N=653). In addition to main trial results, the study yielded numerous secondary analyses, and included a 3.5-year follow-up study, the first of its kind with this population. This paper reviews key findings from POATS and its follow-up study.

Methods: The paper summarizes the POATS design, main outcomes, predictors of outcome, subgroup analyses, the predictive power of early treatment response, and the long-term follow-up study.

Results: POATS examined combinations of buprenorphine-naloxone of varying duration and counseling of varying intensity. The primary outcome analysis showed no overall benefit to adding drug counseling to buprenorphine-naloxone and weekly medical management. Only 7% of patients achieved a successful outcome (abstinence or near-abstinence from opioids) during a 4-week taper and 8-week follow-up; by comparison, 49% of patients achieved success while subsequently stabilized on buprenorphine-naloxone. Long-term follow-up results were more encouraging, with higher abstinence rates than in the main trial. Patients receiving opioid agonist treatment at the time of follow-up were more likely to have better outcomes, though a sizeable number of patients succeeded without agonist treatment. Some patients initiated risky use patterns, including heroin use and drug injection. A limitation of the long-term follow-up study was the low follow-up rate.

Conclusions: POATS was the first large-scale study of the treatment of prescription opioid dependence; its findings can influence both treatment guidelines and future studies.

Keywords: Addiction; Follow-up; Opioid use disorder; Outcome; Prescription opioids; Treatment.

Fig. 1.

The impact of lifetime heroin use and treatment condition on the rate of successful opioid use outcomes on buprenorphine-naloxone in treatment-adherent patients (N = 266).

Fig. 2.

Prognostic significance of opioid abstinence/use in first 4 weeks of buprenorphine-naloxone treatment in predicting abstinence/use in weeks 9–12 (N = 360). The positive predictive value (top) and negative predictive value (bottom) are computed based on abstinence or use, respectively, over the first n weeks of the study, where n varies from 1 to 4. Error bars are 95% confidence intervals.