Buprenorphine/naloxone and methadone effectiveness for reducing craving in individuals with prescription opioid use disorder: Exploratory results from an open-label, pragmatic randomized controlled trial

Affiliations

¹ Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul, Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
² British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada.
³ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 boul, Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada.
⁴ Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, Ontario M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada.
⁵ Department of Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada.
⁶ Unité de recherché Clinique appliquée (URCA), Research Centre, Centre Hospitalier Ste-Justine, 3175 chemin de la Côte Ste-Catherine, Montréal, Québec H3T 1C5, Canada.
⁷ Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul, Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada. Electronic address: didier.jutras-aswad@umontreal.ca.

PMID: 36037586
DOI: 10.1016/j.drugalcdep.2022.109604

Free article

Randomized Controlled Trial

Buprenorphine/naloxone and methadone effectiveness for reducing craving in individuals with prescription opioid use disorder: Exploratory results from an open-label, pragmatic randomized controlled trial

Christina McAnulty et al. Drug Alcohol Depend. 2022.

Free article

. 2022 Oct 1:239:109604.

doi: 10.1016/j.drugalcdep.2022.109604. Epub 2022 Aug 17.

Affiliations

¹ Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul, Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
² British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada.
³ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 boul, Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada.
⁴ Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, Ontario M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada.
⁵ Department of Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada.
⁶ Unité de recherché Clinique appliquée (URCA), Research Centre, Centre Hospitalier Ste-Justine, 3175 chemin de la Côte Ste-Catherine, Montréal, Québec H3T 1C5, Canada.
⁷ Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul, Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada. Electronic address: didier.jutras-aswad@umontreal.ca.

PMID: 36037586
DOI: 10.1016/j.drugalcdep.2022.109604

Abstract

Background: Craving reduction is an important target in the treatment of prescription-type opioid use disorder (POUD). In this exploratory analysis, we compared the effectiveness of BUP/NX flexible model of care relative to methadone for craving reduction in individuals with POUD.

Methods: We analyzed data from a multicentric, pragmatic, 24-week open-label randomized controlled trial conducted in participants with POUD (N = 272) who were randomly assigned to BUP/NX model of care with flexible take-home dosing (n = 138) or the standard model of care with closely supervised methadone (n = 134). Treatments were prescribed and administered according to local guidelines, in diverse clinical settings. Craving was measured using the Brief Substance Craving Scale at baseline, week 2, 6, 10, 14, 18 and 22.

Results: Cravings decreased in both treatment groups over 22 weeks (BUP/NX adjusted mean difference = -5.52, 95% CI = -6.91 to -4.13; methadone adjusted mean difference = -3.95, 95% CI = -5.28 to -2.63; p < 0.001), and were overall lower in the BUP/NX group (adjusted mean = 4.04, 95% CI = 3.43-4.64) than the methadone group (adjusted mean = 5.13, 95% CI = 4.51-5.74; p < 0.001). The time by treatment group interaction (favoring BUP/NX) was statistically significant at week 2 (adjusted mean difference = -1.58, 95% CI = -3.13 to -0.03; p = 0.041).

Conclusions: Compared to the standard methadone model of care, flexible take-home dosing of BUP/NX was associated with lower craving in individuals with POUD. These findings can contribute to guiding shared decision-making regarding OAT treatment in this population.

Trial registration: ClinicalTrials.gov NCT03033732.

Keywords: Buprenorphine/naloxone; Craving; Methadone; Opioid; Opioid-related disorders.

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Conflict of interest statement

Conflict of interest DJA is supported by a research scholar award from the Fonds de Recherche du Québec en Santé. MES is supported by a Michael Smith Foundation for Health Research and St. Paul’s Foundation Scholar Award. CM received financial support from l'Institut universitaire sur les dépendances for the writing and publication of the article. GB received funding for an accelerated passage from master’s to doctorate scholarship from the Université de Montréal. JB is partly financed by a Tier 1 Canada Research chair in Addiction Medicine and receives or has received support from Gilead Sciences and AbbVie, outside of this study. BLF is supported by a clinician scientist award from the Department of Family and Community Medicine and by the Addiction Psychiatry Chair of the Department of Psychiatry, University of Toronto. BLF also receives or has received support from Pfizer Global Research Awards in Nicotine Dependence (GRAND) Program, Brainsway, Bioprojet, Alkermes, Canopy, ACS, and non-financial support from Aurora for work outside this study. MES is supported by a Michael Smith Foundation for Health Research and St. Paul’s Foundation Scholar Award. BLF has a relationship with Indivior that includes consulting and funding grants. SM has a relationship with Indivior that includes consulting. MES has received funding grants from Indivior. AT has a family member who works for ViiV USA. The authors declare no other conflict of interest.

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Buprenorphine/naloxone and methadone effectiveness for reducing craving in individuals with prescription opioid use disorder: Exploratory results from an open-label, pragmatic randomized controlled trial

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Buprenorphine/naloxone and methadone effectiveness for reducing craving in individuals with prescription opioid use disorder: Exploratory results from an open-label, pragmatic randomized controlled trial

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