Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study

• Prescription opioid dependent patients were followed post-treatment for 42 months.
• Long-term outcomes demonstrated clear improvement from baseline.
• 61% were abstinent from illicit opioids, including 29% on agonist therapy.
• Agonist therapy was associated with a greater likelihood of Month-42 abstinence.
• 10% initiated heroin use, and 10% initiated injection heroin use post-treatment.

BackgroundDespite the growing prevalence of prescription opioid dependence, longitudinal studies have not examined long-term treatment response. The current study examined outcomes over 42 months in the Prescription Opioid Addiction Treatment Study (POATS).MethodsPOATS was a multi-site clinical trial lasting up to 9 months, examining different durations of buprenorphine-naloxone plus standard medical management for prescription opioid dependence, with participants randomized to receive or not receive additional opioid drug counseling. A subset of participants (N = 375 of 653) enrolled in a follow-up study. Telephone interviews were administered approximately 18, 30, and 42 months after main-trial enrollment. Comparison of baseline characteristics by follow-up participation suggested few differences.ResultsAt Month 42, much improvement was seen: 31.7% were abstinent from opioids and not on agonist therapy; 29.4% were receiving opioid agonist therapy, but met no symptom criteria for current opioid dependence; 7.5% were using illicit opioids while on agonist therapy; and the remaining 31.4% were using opioids without agonist therapy. Participants reporting a lifetime history of heroin use at baseline were more likely to meet DSM-IV criteria for opioid dependence at Month 42 (OR = 4.56, 95% CI = 1.29–16.04, p < .05). Engagement in agonist therapy was associated with a greater likelihood of illicit-opioid abstinence. Eight percent (n = 27/338) used heroin for the first time during follow-up; 10.1% reported first-time injection heroin use.ConclusionsLong-term outcomes for those dependent on prescription opioids demonstrated clear improvement from baseline. However, a subset exhibited a worsening course, by initiating heroin use and/or injection opioid use.