A comparison of buprenorphine taper outcomes between prescription opioid and heroin users.

Dependence on prescription opioids (PO) is a growing problem. Although most research with buprenorphine has focused on heroin-dependent populations, the authors hypothesize that individuals dependent on PO display characteristics that may predict different outcomes in treatment, particularly in short-term taper procedures in which comorbidities such as pain conditions may complicate taper. This secondary analysis of data from National Drug Abuse Treatment Clinical Trials Network protocol CTN-0003 (Suboxone Taper: A Comparison of Taper Schedules) examined differences in outcomes between PO users (n=90) and heroin users (n=426) after a buprenorphine taper. After a 4-week buprenorphine induction/stabilization phase, 516 opioid-dependent individuals were randomized into 1 of 2 taper lengths (7 vs 28 days) to assess the association between taper length and outcome. The primary outcome was measured by urine drug test for opioids at the end of the taper period. Craving, withdrawal, and buprenorphine dose were also examined. After controlling for baseline demographic and drug use differences between the opioid use groups, results indicate that a higher percentage of the PO group (49%) provided an opioid-free urine drug specimen at the end of taper compared with the heroin group (36%; [chi]21 = 6.592, P < 0.010).

Conclusions: Although buprenorphine taper is not recommended as a stand-alone treatment, there are clinical scenarios where it may be required to taper a patient off buprenorphine, making the findings of this study an important addition to the evidence base in the management of PO dependence with buprenorphine. Results of this secondary analysis additionally confirm the main study’s findings that there seems to be no benefit in prolonging the taper period for PO users beyond 7 days. Should a taper be indicated for a medical reason (for example, for opioid rotation for pain management, or to commence and extended-release naltrexone injection), a 7-day taper seems to be an appropriate schedule. Further studies are required to examine longer-term treatment outcomes.

Related protocols: CTN-0003