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Abstract: Background and aim: Extended-release injectable naltrexone (XR-Naltrexone) is an effective treatment for opioid use disorder (OUD); however, initiation can be challenging as it requires an opioid-free period. This exploratory analysis examines patient characteristics associated with successful initiation of XR-Naltrexone in the National Drug Abuse Treatment Clinical Trials Network (CTN-0051) Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment (X:BOT) trial. Methods: Patient demographics and clinical variables associated with successful XR-Naltrexone initiation were examined among 283 participants with OUD randomized to XR-Naltrexone in the X:BOT trial. Variables included severity of opioid use, characteristics of opioid and other substance use, treatment history, psychiatric history, baseline depression, and pain. Logistic regression models were used to estimate the effect of variables on the odds of induction success. Results: 204 (72%) of 283 participants randomized to receive XR-Naltrexone completed successful induction. Housing status and pain were significantly associated with XR-Naltrexone induction status. Reported homelessness was significantly associated with higher odds of successful XR-Naltrexone induction (OR: 2.31; 95% CI: 1.12, 4.76). Individuals that reported moderate or extreme pain on the EuroQoL had half the odds of successful induction compared to those without pain (OR: 0.49; 95% CI: 0.27, 0.89). Conclusions: Among patients with OUD initiating treatment on inpatient units, homelessness was associated with greater likelihood of successfully initiating XR-Naltrexone, while chronic pain was associated with lower likelihood of XR-Naltrexone initiation. Future research on XR-Naltrexone initiation should consider tailoring treatment based on housing status and other social determinants, and evaluation and management of pain. Related protocols: CTN-0051

Abstract:

Medical cannabis is commonly used for chronic pain, but little is known about differences in characteristics, cannabis use patterns, and perceived helpfulness among primary care patients who use cannabis for pain versus nonpain reasons.

Among 1688 patients who completed a 2019 cannabis survey administered in a health system in Washington state, where recreational use is legal, participants who used cannabis for pain (n = 375) were compared with those who used cannabis for other reasons (n = 558) using survey and electronic health record data. We described group differences in participant characteristics, use patterns, and perceptions and applied adjusted multinomial logistic and modified Poisson regression.

Participants who used cannabis for pain were significantly more likely to report using applied (50.7% vs 10.6%) and beverage cannabis products (19.2% vs 11.6%), more frequent use (47.1% vs 33.1% for use =2 times per day; 81.6% vs 69.7% for use 4 to 7 days per week), and smoking tobacco cigarettes (19.2% vs 12.2%) than those who used cannabis for other reasons. They were also significantly more likely to perceive cannabis as very/extremely helpful (80.5% vs 72.7%), and significantly less likely to use cannabis for nonmedical reasons (4.8% vs 58.8%) or report cannabis use disorder symptoms (51.7% vs 61.1%).

Conclusions: Primary care patients who use cannabis for pain use it more frequently, often in applied and ingested forms, and have more co-use of tobacco, which may differentially impact safety and effectiveness. These findings suggest the need for different approaches to counseling in clinical care.

Related protocols: CTN-0077-Ot

Abstract:

International Classification of Diseases (ICD) diagnosis codes are often used in research to identify patients with opioid use disorder (OUD), but their accuracy for this purpose is not fully evaluated. This study describes application of ICD-10 diagnosis codes for opioid use, dependence and abuse from an electronic health record (EHR) data extraction using data from the clinics’ OUD patient registries and clinician/staff EHR entries.

The study, a secondary analysis of data gathered as part of CTN-0102, a feasibility study about the expansion of medication treatment for OUD in rural communities, used three data sources from each of 4 rural primary care clinics in Washington and Idaho: (1) a limited dataset extracted from the EHR, (2) a clinic-based registry of patients with OUD and (3) the clinician/staff interface of the EHR (e.g. progress notes, problem list). Data source one included records with six commonly applied ICD-10 codes for opioid use, dependence and abuse: F11.10 (opioid abuse, uncomplicated), F11.20 (opioid dependence, uncomplicated), F11.21 (opioid dependence, in remission), F11.23 (opioid dependence with withdrawal), F11.90 (opioid use, unspecified, uncomplicated) and F11.99 (opioid use, unspecified with unspecified opioid-induced disorder). Care coordinators used data sources two and three to categorize each patient identified in data source one: (1) confirmed OUD diagnosis, (2) may have OUD but no confirmed OUD diagnosis, (3) chronic pain with no evidence of OUD and (4) no evidence for OUD or chronic pain.

Analysis found that F11.10, F11.21 and F11.99 were applied most frequently to patients who had clinical diagnoses of OUD (64%, 89% and 79%, respectively). F11.20, F11.23 and F11.90 were applied to patients who had a diagnostic mix of OUD and chronic pain without OUD. The four clinics applied codes inconsistently.

Conclusions: This study found three ICD-10 diagnosis codes (F11.10 [opioid abuse, uncomplicated], F11.21 [opioid dependence, in remission], F11.99 [opioid use, unspecified with unspecified opioid-induced disorder]) that were used more consistently for patients with OUD and others (F11.20 [opioid dependence, uncomplicated], F11.23 [opioid dependence with withdrawal], F11.90 [opioid use, unspecified, uncomplicated]) that were applied to a mix of patients with OUD and patients with chronic pain and no evidence of OUD. Lack of uniform application of ICD diagnosis codes for patients with OUD makes it challenging to use diagnosis code data from the EHR to identify a research population of persons with OUD. Given the richness of the EHR data, it is important to develop new approaches so that researchers can confidently incorporate ICD diagnosis codes in accurately identifying patients with OUD and characterizing their clinical care in their studies.

Related protocols: CTN-0102

Abstract:

Opioid use disorder (OUD) and chronic pain frequently co-occur. Little is known about change in pain during buprenorphine/naloxone (BUP/NX) maintenance and whether outcomes vary by pain levels. The present study examined changes in pain intensity and pain interference over 12 weeks of BUP/NX maintenance among participants with OUD and chronic pain (N=194). Differences in outcomes were assessed during BUP/NX maintenance (Week 12) and 2 months following a BUP/NX taper (Week 24). Data from Phase 2 of the CTN Prescription Opioid Addiction Treatment Study (POATS, CTN-0030) were used. Two latent transition models were conducted to characterize profiles and transitions between profiles of pain intensity or pain interference (estimated separately). Each model identified a high and low profile. In the pain interference model, the majority were classified in the low profile at baseline. In the pain intensity model, the majority were classified in the high profile at baseline. In both models, patients were more likely to remain in or transition to the low profiles by Week 12. Worse depression was associated with membership in the high pain interference profile at both timepoints. Women were more likely to be in the high pain intensity profile at baseline. Those in the high intensity and high pain interference profiles at Week 12 reported worse mental health quality of life (MH-QOL) at Week 12, as well as high pain intensity and high pain interference at Week 24.

Conclusions: For a subgroup of patients, high pain intensity and high pain interference remains unchanged during BUP/NX maintenance treatment.

Related protocols: CTN-0030

Abstract:

Chronic pain is highly prevalent among patients with opioid use disorder (OUD). However, little is known about how pharmacological treatments for OUD, for example, extended-release naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX), affect pain. To begin addressing this question, researchers performed a secondary analysis of pain data on a large prospective 24-week, open-label, randomized-controlled comparative effectiveness trial of XR-NTX versus BUP-NX (X:BOT trial).

Participants’ pain status was measured by the EuroQol (EQ-5D). Based on their responses to the pain question at baseline, participants were dichotomized into “Pain” versus “No Pain” categories. Participant’s pain status was evaluated every 4 weeks. A mixed effects longitudinal logistic regression model was fitted to examine the differential effect of XR-NTX versus BUP-NX on pain, modelling pain at all available follow-up assessments, adjusted for age, sex, and baseline pain.

A total of 474 individuals who were successfully inducted onto their assigned medications were included in this analysis. Among participants endorsing pain at baseline, substantial reductions in pain were observed over the course of the study in both treatment groups. However reduction in pain was slightly greater in the group treated with XR-NTX than the one treated with BUP-NX (OR = 1.60 [95% CI: 1.07–2.40], P = 0.023).

Conclusions: Medication treatments of opioid use disorder were associated with a reduction in self-reported pain in patients reporting pain at the outset of treatment. Although both BUP-NX and XR-NTX were associated with substantial reductions in the proportion of patients reporting pain, XR-NTX was associated with a greater reduction, suggesting that opioid antagonist treatment may benefit patients with comorbid OUD and chronic pain. Future research using instruments and design specifically focused on pain could extend the present observations and evaluate their clinical significance.

Related protocols: CTN-0051

Abstract:

Opioid use disorder (OUD) is associated with chronic pain. This study investigated the association between medication treatments for OUD and pain in a post-hoc secondary analysis of a randomized trial of methadone versus buprenorphine.

1241 individuals with OUD participated in an open label, pragmatic randomized trial of methadone vs. buprenorphine/naloxone in nine treatment programs licensed to dispense agonist medication for OUD between 2006 and 2009. In this post-hoc analysis, pain was dichotomized (present or not present) using responses from the Short Form-36. Logistic regression models were fit to test the effect of (1) having baseline pain on week 24 retention, (2) treatment assignment on improvement in pain among those reporting pain at baseline, and (3) pain improvement at week 4 on 233k 24 retention among those reporting pain at baseline.

Analysis revealed that almost half (48.2%) of the sample reported pain at baseline. Participants with baseline pain did not significantly differ in week 24 retention compared to those without baseline pain. Among those reporting pain at baseline, there was no significant difference between treatment arms in improvement of pain at week 4, but improvement in pain at week 4 was associated with significantly greater odds of being retained at week 24.

Conclusions: Despite limitations, this study highlights the high prevalence of baseline pain in individuals with OUD and the significant portion of those individuals who continue to report pain despite treatment with agonist medication. Further research is needed to confirm the findings of this study, including the association between pain and retention and pain outcomes in individuals on medications for OUD.

Related protocols: CTN-0027

Abstract:

Opioid use disorder (OUD) is associated with excess mortality, morbidities, and other adverse health and social conditions. OUD is common among individuals with chronic pain conditions, and chronic pain is common among individuals with OUD. The relationship between chronic pain and OUD and the time course of the two is complex and other physical and mental health problems often co-occur with them both as well. The goal of this study was to examine chronic pain among patients with OUD, as well as to examine other substance use disorders, health, mental health, and treatment for health and mental health among patients in medical settings using electronic health records (EHRs).

Using an EHR database from 2006-2015, the study assessed 5307 adult patients with OUD in a large healthcare system (University of California, Los Angeles, CTN Pacific Region Node), separating them into four categories: no chronic pain (No Pain, 35.6%), OUD prior to pain (OUD First, 9.7%), OUD and pain at the same time (Same Time, 14.9%), and pain condition prior to OUD (Pain First, 39.8%).

Most OUD patients (64.4%) had chronic pain conditions, and among them 61.8% had chronic pain before their first OUD diagnosis. Other SUDs occurred more frequently among OUD First patients than among other groups in terms of alcohol (33.4% vs. 25.4% for No Pain, 20.7% for Same Time, and 20.3% for Pain First), cocaine (19% vs 13.8%, 9.4%, 7.1%), and alcohol or drug-induced disorders. OUD First patients also had the highest rates of HIV (4.7%) and hepatitis C virus (28.2%) among the four groups. Pain First patients had the highest rates of mental disorder (81.7%), heart disease (72%), respiratory disease (68.4%), sleep disorder (41.8%), cancer (23.4%), and diabetes (19.3%).

Conclusions: The alarming high rates of chronic pain conditions occurring before OUD and the associated severe mental health and physical health conditions require better models of assessment and coordinated care plans to address these complex medical conditions.

Abstract:

Recent evidence suggests that women may fare worse than men in cannabis trials with pharmacologic interventions. Identifying baseline clinical profiles of treatment-seeking cannabis-dependent adults could inform gender-specific treatment planning and development. The current study compared baseline demographic, cannabis use, and psychiatric factors between women (n=86) and men (n=216) entering the Achieving Cannabis Cessation-Evaluating N-acetylcysteine Treatment (ACCENT) study, a multi-site randomized controlled trial conducted within the National Drug Abuse Treatment Clinical Trials Network.

Results found that women reported greater withdrawal intensity (p=.001) and negative impact of withdrawal (p=.001), predominantly due to physiological and mood symptoms. Women were more likely to have lifetime panic disorder (p=.038) and current agoraphobia (p=.022), and reported more days of poor physical health (p=.006) and cannabis-related medical problems (p=.023). Women reporting chronic pain had greater mean pain scores than men with chronic pain (p=.006). Men and women did not differ on any measures of baseline cannabis use.

Conclusions: Cannabis-dependent women may present for treatment with more severe and impairing withdrawal symptoms and psychiatric conditions compared to cannabis-dependent men. This might help explain recent evidence suggesting that women fare worse than men in cannabis treatment trials of pharmacologic interventions. Baseline clinical profiles of treatment-seeking adults can inform gender-specific treatment planning and development. Cannabis-dependent women may benefit from integrated treatment focusing on co-occurring psychiatric disorders and targeted treatment of cannabis withdrawal syndrome.

Related protocols: CTN-0053

Abstract:

Buprenorphine-naloxone (BUP-NLX) can be used to manage prescription opioid addiction among persons with chronic pain, but post-treatment relapse is common and difficult to predict. This study, a secondary analysis of data from the CTN’s Prescription Opioid Addiction Treatment Study (POATS), estimated whether changes in pain over time and pain volatility during BUP-NLX maintenance would predict opioid use during the BUP-NLX taper. Study participants, from community clinics affiliated with POATS in 10 U.S. cities, were subjects with chronic pain who entered the BUP-NLX taper phase (N=125), with enrollment occurring from June 2006 to July 2009 (52% male, 88% Caucasian, 31% married). Outcomes were weekly biologically-verified and self-reported opiate use from the 4-week taper phase. Predictors were estimates of baseline severity, rate of change, and volatility in pain from weekly self-reports during the 12-week maintenance phase.

Controlling for baseline pain and treatment condition, increased pain and greater pain volatility predicted greater odds of positive opioid urine screen during BUP-NLX taper. Increased pain and greater pain volatility also predicted greater frequency of self-reported opioid use.

Conclusions: Adults with chronic pain receiving outpatient treatment with buprenorphine-naloxone (BUP-NLX) for prescription opioid addiction have elevated risk for opioid use when tapering off maintenance treatment. Those with relative persistence in pain over time and greater volatility in pain during treatment are less likely to sustain abstinence during BUP-NLX taper. These findings suggest that stabilizing and/or reducing subjective pain prior to discontinuation of BUP-NLX maintenance may be a means to improve treatment outcomes in this population.

Related protocols: CTN-0030

Abstract:

Patients with prescription opioid use disorder commonly report relief of chronic pain as the chief reason for first opioid use; indeed, the prevalence of chronic pain is high in this population. Understanding the association between pain severity and subsequent opioid use is crucial for understanding how to manage these conditions simultaneously and has not been examined in this population. The aim of this analysis was to examine the proximal effect of pain severity on opioid use during 12 weeks of buprenorphine-naloxone therapy for patients with chronic pain and prescription opioid use disorder.

This study is a secondary analysis of the NIDA Clinical Trials Network’s randomized, controlled trial of buprenorphine-naloxone plus counseling for prescription opioid dependent patients (CTN-0030, Prescription Opioid Addiction Treatment Study (POATS)). The association between past-week pain severity and opioid use in the subsequent week was examined in 148 patients presenting with chronic pain at baseline. Results from a multivariable logistic regression model showed that greater pain severity in a given week was significantly associated with increased odds of opioid use in the following week over the 12-week treatment, even after adjusting for covariates associated with opioid use (aOR=1.15, p<.001).

Conclusions: This longitudinal study is the first examination of the association between pain severity and subsequent opioid use in patients with prescription opioid use disorder. Despite previous reports of no association between baseline pain and subsequent opioid use, these findings suggest that patients who experience flare-ups of pain during treatment are prone to relapse to opioid use. Understanding the mechanism by which pain flare-ups may lead to substance use would be clinically meaningful; identification of those who are at risk to use opioids may be facilitated by carefully monitoring patterns of pain intensity over time.

Related protocols: CTN-0030

Abstract:

The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This secondary analysis of Phase 2 of the NIDA Clinical Trials Network’s multisite “Prescription Opioid Addiction Treatment Study” (POATS), examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction.

Secondary analyses of adults with chronic pain (n=149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in POATS were conducted. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p < .001). Patients with greater pain volatility were less likely to have a good treatment outcome (odds ratio = 0.55, p < .05), controlling for baseline pain severity and rate of change in pain over time. 1 standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence.

Conclusions: The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Clinicians providing treatment for co-occurring prescription opioid addiction and chronic pain may want to consider monitoring pain volatility to monitor for risk for poor treatment outcomes and adjust treatment regimens accordingly. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain.

Related protocols: CTN-0030

Abstract:

Although prescription opioid use disorder has recently increased sharply in the United States, relatively little is known about the general well-being of this population. Assessment of quality of life in patients with substance use disorders has been recommended to improve clinical care. In this study, health-related quality of life was examined in prescription opioid-dependent patients at entry to the National Drug Abuse Treatment Clinical Trials Network’s “Prescription Opiate Addiction Treatment Study (POATS)”, a national multi-site trial, to compare quality of life scores in the study sample to other populations. Background variables associated with quality of life in the literature were also examined.

Prescription opioid-dependent patients (N=653) were compared to general populations on the Medical Outcome Study Short Form-36 (SF-36) quality of life measure, and the association between patient background variables and quality of life was examined. Compared to a general population, the current sample of prescription opioid-dependent patients had worse physical and mental quality of life as measured by the SF-36, similar to other opioid-use disorder populations. Within this sample, women showed more impairment than men in mental quality of life, while older patients scored worse on physical, but not mental, quality of life. Chronic pain was associated with poorer physical quality of life.

Conclusions: The growing focus on wellness underscores the importance of measuring quality of life in addition to substance use outcomes. Routine assessment of health-related quality of life can add an important dimension to overall evaluation of patients’ treatment response. Furthermore, brief, widely-used measures of health-related quality of life such as the SF-36 enable comparisons of these factors between different patient populations and can inform both clinical treatment selection and policy decisions about the allocation of health care resources.

Related protocols: CTN-0030

Abstract:

The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in National Drug Abuse Treatment Clinical Trials Network protocol CTN-0030, Prescription Opiate Abuse Treatment Study (POATS), a randomized controlled trial of treatment for prescription opioid dependence.

Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reasons for use — over 80% of those with chronic pain and 49% of those without it reported that pain relief was their primary reason for initiating opioid use. Participants without chronic pain were significantly more likely than those with chronic pain to report that their reason for initiating use was to get high (39% vs. 13%). Other reasons for initiating use (e.g., to improve sleep or reduce anxiety) were relatively uncommon in both groups. In terms of current reasons for opioid use, participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. However, avoiding withdrawal was rated as the most important reason for current prescription opioid use, regardless of chronic pain status.

Conclusions: These findings highlight the important role of physical pain in both the initiation and maintenance of prescription opioid use in patients with chronic pain. The finding that avoidance of withdrawal was the most important reason for current use is consistent with the key role that physical dependence plays in maintaining opioid dependence. Incorporating pain-focused content and referral for pain evaluation as part of standard treatments for opioid dependence may benefit patients with co-occurring chronic pain.

Related protocols: CTN-0030

Abstract:

This Blending Initiative Workshop focused on clinical management of prescription opioid use disorders and screening and brief intervention for substance use disorders in the emergency department. [view flyer | view agenda]

View videos in order by clicking on player window (to advance to the next video in the playlist, hover over the screen and click the >>| button at the bottom), or individually using the links below.

Session 1: Clinical Management of Prescription Opioid Use Disorders (moderator: Andrew J. Saxon, MD)

• Introduction to the Workshop — Andrew J. Saxon, MD and Megan L. Ranney, MD, MPH
• ACEP Clinical Policy: Review and Implementation of the Clinical Guideines — Knox H. Todd, MD, MPH, FACEP
• Hard Conversations: Addressing Patients with Chronic Pain — Kavita M. Babu, MD, FACEP, FACMT
• Facilitation Through Technology: Prescription Drug Monitoring Programs — Edward W. Boyer, MD, PhD

Session 2: Panel Discussion of Working and Successful Models

• North Carolina Emergency Department Care Coordination Trial — Chris L. Ringwalt, DrPH
• A Randomized Controlled Trial of Citywide Emergency Department Care Coordination — Darin E. Nevin, MD, MS
• Guidance for Opioid Prescribing: Lessons Learned from the NYC Experience — Lewis S. Nelson, MD, FACEP
• Rural Strategy to Reduce Drug Diversion — John J. Graykowski, MPAS, PA-C
• Morning Panel Discussion

Luncheon Roundtable Discussion: Implementation and Application of ACEP Clinical Policy Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department. Moderated by Lewis S. Nelson, MD, FACEP and Knox H. Todd, MD, MPH, FACEP

Session 4: Screening and Brief Intervention for Substance Use Disorders (moderator: Megan L. Ranney, MD, MPH)

• Overview of Screening and Brief Intervention in the Emergency Department — Gail D’Onofrio, MD, MS, FACEP
• Addressing Patients with Comorbid Conditions — Douglas F. Zatzick, MD
• Using Technology to Facilitate SBIRT: Web and Computer-Based Screening and Brief Intervention — Rebecca M. Cunningham, MD

Session 5: Panel Discussion of Working and Successful Models

• Training Trauma Center Clinicians to Perform Screening and Brief Intervention: Results from a National Training Effort — Christopher W. Dunn, PhD
• Statewide Dissemination of Emergency Room Screening and Brief Intervention: Lessons Learned Blending Research and Practice — Edward Bernstein, MD, FACEP
• Implementation of a Screening and Brief Intervention Program in a Large Safety-Net Trauma Center — Kerryann B. Broderick, MD, BSN, FACEP
• Screening and Brief Intervention Strategies for Emergency Nurses — Patricia K. Howard, PhD, RN, CEN, CPEN, NC-BC, FAEN
• Afternoon Panel Discussion

Abstract:

The ten-site Prescription Opioid Addiction Treatment Study (POATS), conducted as part of the National Drug Abuse Treatment Clinical Trials Network (CTN), examined different lengths of buprenorphine-naloxone (bup-nx) treatment with different intensities of counseling for patients dependent upon prescription opioids. The aim of the study described in this poster is to examine predictors of treatment outcome in this patient population. A two-phase adaptive treatment research designed examined outcomes: 1) during a brief taper and 2) while maintained on bup-nx for 12 weeks. “Successful outcome” was defined as abstinence in week 12 of Phase 2 (the last week of bup-nx stabilization) and greater-than/equal-to 2 of the previous 3 weeks (weeks 9-11). Sociodemographic and clinical characteristics were examined as predictors of successful outcome. Bivariate analyses revealed several predictors of successful outcome. Those who had never used heroin were more likely to achieve successful outcomes than those who had never used heroin (54% vs. 37%). Those reporting sustained-release oxycodone as the primary opioid used in the 30 days before baseline had fewer successful outcomes (41%) than did those who primarily used other opioids (58%). Those who had never attended self-help meetings had more successful outcomes than those who had ever done so (52% vs. 38%). Other predictors of successful outcome included major depressive disorder in the past year (64% of those with the diagnosis vs. 46% of those without) and being older (mean of 33.9 years vs. 31.2 years). The presence of chronic pain at baseline did not predict outcome. In conclusion: among patients with prescription opioid dependence, characteristics traditionally associated with addiction (use of heroin, absence of psychiatric illness, attendance at self-help meetings) were associated with poorer outcomes. Further examination of these variables may help to understand the interrelationships among them.

Related protocols: CTN-0030