Predictors of outcome for short-term medically supervised opioid withdrawal during a randomized, multicenter trial of buprenorphine-naloxone and clonidine in the NIDA clinical trials network drug and alcohol dependence

Douglas M. Ziedonis, Leslie Amass, Marc Steinberg, George Woody, Jonathan Krejci, Jeffrey J. Annon, Allan J. Cohen, Nancy Waite-O'Brien, Susan M. Stine, Dennis McCarty, Malcolm S. Reid, Lawrence S. Brown, Robert Maslansky, Theresa Winhusen, Dean Babcock, Greg Brigham, Joan Muir, Deborah Orr, Betty J. Buchan, Terry Horton & 1 others Walter Ling

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Few studies in community settings have evaluated predictors, mediators, and moderators of treatment success for medically supervised opioid withdrawal treatment. This report presents new findings about these factors from a study of 344 opioid-dependent men and women prospectively randomized to either buprenorphine-naloxone or clonidine in an open-label 13-day medically supervised withdrawal study. Subjects were either inpatient or outpatient in community treatment settings; however not randomized by treatment setting. Medication type (buprenorphine-naloxone versus clonidine) was the single best predictor of treatment retention and treatment success, regardless of treatment setting. Compared to the outpatient setting, the inpatient setting was associated with higher abstinence rates but similar retention rates when adjusting for medication type. Early opioid withdrawal severity mediated the relationship between medication type and treatment outcome with buprenorphine-naloxone being superior to clonidine at relieving early withdrawal symptoms. Inpatient subjects on clonidine with lower withdrawal scores at baseline did better than those with higher withdrawal scores; inpatient subjects receiving buprenorphine-naloxone did better with higher withdrawal scores at baseline than those with lower withdrawal scores. No relationship was found between treatment outcome and age, gender, race, education, employment, marital status, legal problems, baseline depression, or length/severity of drug use. Tobacco use was associated with worse opioid treatment outcomes. Severe baseline anxiety symptoms doubled treatment success. Medication type (buprenorphine-naloxone) was the most important predictor of positive outcome; however the paper also considers other clinical and policy implications of other results, including that inpatient setting predicted better outcomes and moderated medication outcomes.

Original languageEnglish (US)
Pages (from-to)28-36
Number of pages9
JournalDrug and Alcohol Dependence
Volume99
Issue number1-3
DOIs
StatePublished - Jan 1 2009

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Clonidine
Opioid Analgesics
Alcoholism
Multicenter Studies
Substance-Related Disorders
Alcohols
Clinical Trials
Inpatients
Pharmaceutical Preparations
Therapeutics
Moderators
Tobacco
Outpatients
Labels
Substance Withdrawal Syndrome
Education
Naloxone Drug Combination Buprenorphine
N-nitrosoiminodiacetic acid
Marital Status
Tobacco Use

Keywords

  • Buprenorphine
  • Clinical trial
  • Detoxification
  • Heroin dependence
  • Opiate withdrawal
  • Outcome predictors

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Toxicology
  • Pharmacology
  • Pharmacology (medical)

Cite this

Predictors of outcome for short-term medically supervised opioid withdrawal during a randomized, multicenter trial of buprenorphine-naloxone and clonidine in the NIDA clinical trials network drug and alcohol dependence. / Ziedonis, Douglas M.; Amass, Leslie; Steinberg, Marc; Woody, George; Krejci, Jonathan; Annon, Jeffrey J.; Cohen, Allan J.; Waite-O'Brien, Nancy; Stine, Susan M.; McCarty, Dennis; Reid, Malcolm S.; Brown, Lawrence S.; Maslansky, Robert; Winhusen, Theresa; Babcock, Dean; Brigham, Greg; Muir, Joan; Orr, Deborah; Buchan, Betty J.; Horton, Terry; Ling, Walter.

In: Drug and Alcohol Dependence, Vol. 99, No. 1-3, 01.01.2009, p. 28-36.

Research output: Contribution to journalArticle

Ziedonis, DM, Amass, L, Steinberg, M, Woody, G, Krejci, J, Annon, JJ, Cohen, AJ, Waite-O'Brien, N, Stine, SM, McCarty, D, Reid, MS, Brown, LS, Maslansky, R, Winhusen, T, Babcock, D, Brigham, G, Muir, J, Orr, D, Buchan, BJ, Horton, T & Ling, W 2009, 'Predictors of outcome for short-term medically supervised opioid withdrawal during a randomized, multicenter trial of buprenorphine-naloxone and clonidine in the NIDA clinical trials network drug and alcohol dependence', Drug and Alcohol Dependence, vol. 99, no. 1-3, pp. 28-36. https://doi.org/10.1016/j.drugalcdep.2008.06.016
Ziedonis, Douglas M. ; Amass, Leslie ; Steinberg, Marc ; Woody, George ; Krejci, Jonathan ; Annon, Jeffrey J. ; Cohen, Allan J. ; Waite-O'Brien, Nancy ; Stine, Susan M. ; McCarty, Dennis ; Reid, Malcolm S. ; Brown, Lawrence S. ; Maslansky, Robert ; Winhusen, Theresa ; Babcock, Dean ; Brigham, Greg ; Muir, Joan ; Orr, Deborah ; Buchan, Betty J. ; Horton, Terry ; Ling, Walter. / Predictors of outcome for short-term medically supervised opioid withdrawal during a randomized, multicenter trial of buprenorphine-naloxone and clonidine in the NIDA clinical trials network drug and alcohol dependence. In: Drug and Alcohol Dependence. 2009 ; Vol. 99, No. 1-3. pp. 28-36.
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