The relationship between primary prescription opioid and buprenorphine-naloxone induction outcomes in a prescription opioid dependent sample.

This secondary analysis of data from the National Drug Abuse Institute Clinical Trials Network study CTN-0030 (Prescription Opioid Addiction Treatment Study (POATS)) aimed to compare induction experiences among participants who self-reported using one of the four most commonly reported prescription opioids (POs) and examine factors associated with difficult buprenorphine-naloxone (bup-nx) induction. The Prescription Opioid Addiction Treatment Study was a multi-site, randomized clinical trial using a two-phase adaptive treatment research design. This analysis examined bup-nx induction of participants who self-reported primary PO use of methadone, ER-oxycodone, IR-oxycodone, and hydrocodone (n=569). Analyses examined characteristics associated with difficult induction, defined as increased withdrawal symptoms measured by the Clinical Opiate Withdrawal Scale (COWS) after the first bup-nx dose with higher scores denoting greater withdrawal symptoms/severity. Contrary to the study’s hypothesis, difficult induction experiences did not differ by primary PO type. Those who experienced a post-induction increase in COWS score had lower pre-dose COWS scores compared to those who did not experience a post-induction increase in COWS score (10.09 vs. 12.77). Demographics characteristics, depression, and pain history did not predict a difficult induction.

Conclusions: Difficult bup-nx inductions were not associated with participants’ primary PO. Severity of withdrawal, measured with the COWS, was an important variable, reminding clinicians that bup-nx should not be commenced prior to evidence of moderate opioid withdrawal. These findings add to the evidence that with careful procedures, bup-nx can be used with few difficulties in PO-dependent patients.

Related protocols: CTN-0030