From START to finish: National and international perspectives on disseminating research to practice for the treatment of opioid dependence.

To date, the National Drug Abuse Clinical Trials Network Starting Treatment with Agonist Replacement Treatment Study (START) includes the largest database of patients (n=1269) entering opioid agonist treatment programs at community methadone centers around the United States (U.S.). Participants in the study were randomized to either Methadone (MET) treatment or Buprenorphine/Naloxone (BUP/Nx) treatment, and closely monitored during induction as well as throughout active treatment and follow-up. Pharmacotherapy was provided for 24 weeks with taper or continuation possible through week 32. Primary outcomes showed low rates of liver injury and no differences in liver functions between MET and BUP/Nx groups. Secondary findings present a multitude of interesting and clinically relevant outcomes. This Blending Initiative workshop presented several of those secondary outcomes from both a U.S. and international perspective.

Session One: United States Perspective

This segment of the session presented several important secondary outcomes from the START study including: From a comparison of the impact of MET vs. BUP/Nx treatment on HIV risk behaviors; a description of six different BUP/Nx and three different MET induction trajectories and their outcomes; and an association between genotype and treatment outcome in African-American participants receiving BUP/Nx or MET.

Session Two: International Perspective

To complement the findings and dissemination strategies from the U.S. perspective, a panel of international collaborators presented findings from studies conducted abroad and implementation strategies that have been successful. Presentations included outcomes from a collaborative project between NIDA and treatment providers in Indonesia, data from epidemiological studies showing the association between the length of MET treatment and mortality rates and dissemination and implementation strategies, and the use of incentive-based interventions in reducing drug use and associated consequences. The session also described the N-ALIVE (NALoxone InVEstigation) study–a large, prison-based, trial that assesses the number of lives that could be saved by providing Naloxone-on-release to adult prisoners with a history of heroin injection. The discussion after session two focused on on how the knowledge gained from these analyses and findings can be translated for the implementation of relevant MET or BUP/Nx treatment in clinical settings treating opioid dependent patients in the U.S. as well as internationally

Related protocols: CTN-0027