Baseline characteristics and treatment outcomes in prescription opioid dependent patients with and without co-occurring psychiatric disorder.
Given the growing prevalence of prescription opioid dependence and the considerable rates of additional psychopathology in drug dependence, this study examined the association between the presence of a co-occurring Axis I psychiatric disorder and sociodemographic and clinical characteristics in this secondary analysis of patients entering a treatment study for dependence on prescription opioids. Treatment outcomes were also compared. Patients dependent on prescription opioids participated in a multi-site, two-phase, randomized, controlled trial to assess different lengths of buprenorphine-naloxone pharmacotherapy and different intensities of counseling (National Drug Abuse Treatment Clinical Trials Network protocol CTN-0030, Prescription Opioid Addiction Treatment Study (POATS)). Among the 653 participants entering the first phase of the trial, 360 entered the second phase, receiving 12 weeks of buprenorphine-naloxone treatment; they are reported here. Half of those participants (180/360) had a current co-occurring psychiatric disorder in addition to substance dependence. Sociodemographic characteristics were similar overall between those with and without a co-occurring psychiatric disorder, but women were 1.6 times more likely than men to have a co-occurring disorder. On several clinical indicators at baseline, participants with a co-occurring disorder had greater impairment. However, they had better opioid use outcomes at the conclusion of 12 weeks of buprenorphine-naloxone stabilization than did participants without a co-occurring disorder.
Conclusions: Prescription opioid-dependent patients with a co-occurring psychiatric disorder had a better response to buprenorphine-naloxone treatment despite demonstrating greater impairment at baseline. This finding emphasizes the importance of conducting psychiatric assessments in substance dependence treatment settings so that clinicians are best able to understand and serve patients. Additional research is needed to determine the mechanism of this finding and to adapt treatments to address this population.
Related protocols: CTN-0030