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Randomized Controlled Trial
. 2022 Dec:143:108830.
doi: 10.1016/j.jsat.2022.108830. Epub 2022 Jun 22.

Polysubstance use before and during treatment with medication for opioid use disorder: Prevalence and association with treatment outcomes

Amanda M Bunting  1 , Noa Krawczyk  2 , Tse-Hwei Choo  3 , Martina Pavlicova  3 , Jennifer McNeely  2 , Babak Tofighi  2 , John Rotrosen  4 , Edward Nunes  5 , Joshua D Lee  6
Affiliations
Randomized Controlled Trial

Polysubstance use before and during treatment with medication for opioid use disorder: Prevalence and association with treatment outcomes

Amanda M Bunting et al. J Subst Abuse Treat. 2022 Dec.

Abstract

Objective: Polysubstance use may complicate treatment outcomes for individuals who use opioids. This research aimed to examine the prevalence of polysubstance use in an opioid use disorder treatment trial population and polysubstance use's association with opioid relapse and craving.

Methods: This study is a secondary data analysis of individuals with opioid use disorder who received at least one dose of medication (n = 474) as part of a 24-week, multi-site, open label, randomized Clinical Trials Network study (CTN0051, X:BOT) comparing the effectiveness of extended-release naltrexone versus buprenorphine. Models examined pretreatment polysubstance use and polysubstance use during the initial 4 weeks of treatment on outcomes of relapse by week 24 of the treatment trial and opioid craving.

Results: Polysubstance use was generally not associated with treatment outcomes of opioid relapse and craving. Proportion of days of pretreatment sedative use was associated with increased likelihood of opioid relapse (OR: 1.01, 95 % CI: 1.00-1.02). Proportion of days of cocaine use during the initial 4 weeks of treatment was associated with increased likelihood of opioid relapse (OR: 1.05, 95 % CI: 1.01-1.09) but this effect was no longer significant once the potential of confounding by opioid use was considered. Sedative use during initial 4 weeks of treatment was associated with increased opioid craving (b: 0.77, 95 % CI: 0.01-1.52). The study found no other significant relationships.

Conclusions: In the current study population, polysubstance use was only marginally associated with 24-week treatment outcomes.

Keywords: Buprenorphine; Naltrexone; Opioid use disorder; Polysubstance use; Treatment.

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Conflict of interest statement

Declaration of competing interest Dr. Rotrosen is and has been, a Principal Investigator or a co-Investigator on studies for which support in the form of donated or discounted medication and/or funds has been, or will be, provided by Alkermes, Inc. (Vivitrol, extended-release injectable naltrexone), Indivior, Inc. (formerly Reckitt-Benckiser; Suboxone, buprenorphine/naloxone combination), and Braeburn Pharmaceuticals, Inc. (extended-release injectable buprenorphine); and digital therapeutics from Pear Therapeutics (smartphone apps ReSET and ReSET-O), CHESS Health (Connections smartphone app), and Data Cubed (smartphone apps SOAR and mSAPPORT). None of this support has gone, or will go, directly to him, rather to either NYU, or to NIDA/NIH, or to NIDA's contractor Emmes, Inc. Dr. Rotrosen recently served in a non-paid capacity as a member of an Alkermes study Steering Committee. He has no relevant equity, intellectual property, paid consulting, travel or other arrangements with any of these entities. Dr. McNeely declares intellectual property interests in the Substance Use Screening and Intervention Tool (SUSIT), which is in the public domain and unrelated to this work. Dr. Lee has received in-kind study drug for recent and current NIDA-funded trials from Alkermes Inc. and Indivior PLC. Dr. Lee has received a recent investigator sponsored study grant from Indivior PLC. Dr. Lee is a science advisor to Oar Health LLC. Dr. Nunes received medication for studies from Alkermes (Vivitrol), Indivior (Suboxone, Sublocade), and Braeburn (CAM2038/Brixadi), received technology for studies from Pear Therapeutics, CHESS Health, served as an unpaid consultant to Alkermes, Braeburn/Camurus, Pear Therapeutics, and has been an investigator on studies by Braeburn Pharmaceuticals (CAM2038/Brixadi). Dr. Tofighi is a consultant to Oar Health LLC.

Figures

Fig. 1.
Fig. 1.
Polysubstance use during the 1st 4 weeks of treatment.
See this image and copyright information in PMC

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