Sex differences in weight gain during medication-based treatment for opioid use disorder: A meta-analysis and retrospective analysis of clinical trial data

Weight change in a national cohort of U.S. Military Veterans engaged in medication treatment for opioid use disorder

Medication treatments for opioid use disorder (MOUD) save lives and improve outcomes for countless individuals. However, data suggest the potential for significant weight gain during methadone treatment and little is known about weight change during buprenorphine treatment. Using Veteran Health Administration administrative data from fiscal year 2017 to fiscal year 2019, two cohorts were created: 1) Veterans diagnosed with opioid use disorder (OUD) taking methadone (N = 1425); and 2) Veterans diagnosed with OUD taking buprenorphine (N = 3756). Linear mixed models were used to analyze weight change during the first MOUD treatment episode in the observation period. Random slopes and intercepts were included in the model to estimate variation in BMI across individuals and time. The data revealed a slight upward trend in BMI over the course of treatment. Specifically, a daily increase of 0.004 for Veterans in methadone treatment and 0.002 for Veterans in buprenorphine treatment was observed. This translates to a gain of about 10 pounds over the course of 1 year of methadone treatment and 5 pounds for 1 year of buprenorphine treatment for a Veteran of average height and weight. The amount of weight gain in methadone treatment is significantly less than other published findings, but nonetheless indicates that assessment and discussions between patients and providers related to weight may be warranted.

Weight change among patients engaged in medication treatment for opioid use disorder: a scoping review

Background: Medication treatment for opioid use disorder (MOUD) is an instrumental tool in combatting opioid use and overdose. Excess weight gain associated with MOUD initiation is a potential barrier that is not well understood.Objectives: Conduct a scoping review of available studies investigating the effect of MOUD on weight.Methods: Included studies consisted of adults taking any type of MOUD (e.g. methadone, buprenorphine/naloxone, naltrexone) with data on weight or body mass index for at least two time points. Evidence was synthesized using qualitative and descriptive approaches, and predictors of weight gain including demographics, comorbid substance use, and medication dose were examined.Results: Twenty-one unique studies were identified. Most studies were uncontrolled cohort studies or retrospective chart reviews testing the association between methadone and weight gain (n = 16). Studies examining 6 months of methadone treatment reported weight gain ranging from 4.2 to 23.4 pounds. Women appear to gain more weight from methadone than men, while patients using cocaine may gain less. Racial and ethnic disparities were largely unexamined. Only three case reports and two nonrandomized studies examined the effects of either buprenorphine/naloxone or naltrexone, and potential associations with weight gain were not clear.Conclusion: The use of methadone as an MOUD appears to be associated with mild to moderate weight gain. In contrast, there is little data supporting or refuting weight gain with buprenorphine/naloxone or naltrexone. Providers should discuss the potential risk for weight gain with patients as well as prevention and intervention methods for excess weight gain.

Metabolic profiles associated with opioid use and opioid use disorder: a narrative review of the literature

Purpose of Review

Opioid use disorder (OUD) is a chronic, relapsing condition that is epidemic in the USA. OUD is associated with serious adverse consequences, including higher incarceration rates, impaired medical and mental health, and overdose-related fatalities. Several medications with demonstrated clinical efficacy in reducing opioid use are approved to treat OUD. However, there is evidence that medications for OUD cause metabolic impairments, which raises concerns over the long-term metabolic health of individuals recovering from OUD. Here, we summarize the scientific literature on the metabolic effects of the use of opioids, including medications for treating OUD.

Recent Findings

Our findings showed lower body weight and adiposity, and better lipid profiles in individuals with OUD. In individuals with diabetes mellitus, opioid use was associated with lower blood glucose levels. In contrast, among individuals without underlying metabolic conditions, opioids promoted insulin resistance. Treatment of OUD patients with the agonists methadone or buprenorphine caused weight gain, increased liking and intake of sugar, and impaired lipid profile and glucose metabolism, whereas treatment with the antagonist naltrexone demonstrated evidence for reduced sweet preferences.

Summary

Our findings highlighted a gap in knowledge regarding the safety of medications for OUD. Further research is needed to determine how best to reduce the risk of metabolic disorder in the treatment of OUD with opioid agonists versus antagonists.

The impact of body image dissatisfaction on psychological distress and health-related quality of life among patients in methadone treatment

BACKGROUND AND OBJECTIVES

Minimal research has examined body image dissatisfaction (BID) among patients receiving methadone maintenance treatment (MMT). We tested associations between BID and MMT quality indicators (psychological distress, mental and physical health-related quality of life [HRQoL]) and whether these associations varied by gender.

METHODS

One hundred and sixty-four participants (n = 164) in MMT completed self-report measures of body mass index (BMI), BID, and MMT quality indicators. General linear models tested if BID was associated with MMT quality indicators.

RESULTS

Patients were primarily non-Hispanic White (56%) men (59%) with an average BMI in the overweight range. Approximately 30% of the sample had moderate or marked BID. Women and patients with a BMI in the obese range reported higher BID than men and patients with normal weight, respectively. BID was associated with higher psychological distress, lower physical HRQoL, and was unrelated to mental HRQoL. However, there was a significant interaction in which the association between BID and lower mental HRQoL was stronger for men than women.

DISCUSSION AND CONCLUSIONS

Moderate or marked BID is present for about three in 10 patients. These data also suggest that BID is tied to important MMT quality indicators, and that these associations can vary by gender. The long-term course of MMT may allow for assessing and addressing novel factors influencing MMT outcomes, including BID.

SCIENTIFIC SIGNIFICANCE

This is one of the first studies to examine BID among MMT patients, and it highlights MMT subgroups most at risk for BID and reduced MMT quality indicators due to BID.

Association between body mass index and treatment completion in extended-release naltrexone-treated patients with opioid dependence

Background

Excessive consumption of opioids is associated with impaired metabolic function including increased body mass index (BMI). Opioid antagonist naltrexone (NTX) is an effective treatment for opioid use disorder (OUD) that has the potential to mitigate such metabolic disturbances. Understanding the relationship between treatment adherence and BMI in NTX-treated OUD patients may provide valuable insights into optimizing clinical outcomes.

Methods

Patients with opioid dependence were offered up to three monthly injections of extended-release (XR) NTX. Treatment completers (n = 41) were defined as those who had received all three XR-NTX injections, and non-completers (n = 20) as those missing at least one injection. Logistic regression was performed to examine the association between pre-treatment BMI and treatment completion.

Results

BMI was positively associated with treatment completion. This association remained significant after adjusting for potentially confounding variables.

Conclusion

Our findings suggest that baseline BMI may serve as a potential predictor of XR-NTX treatment adherence in patients with OUD and could help healthcare providers and policy makers alike in developing strategies to improve retention and tailor interventions for specific patient subgroups.

Ketogenic diet enhances the effects of oxycodone in mice

Opioids have been used to manage pain for thousands of years, but they have significant potential for abuse. Prescription opioids, like oxycodone, are associated with 32% of overdoses, that have reached a total of 75,673 deaths in 2021. A major challenge is maximizing their therapeutic potential while minimizing the negative side effects including opioid use disorder (OUD). The Ketogenic Diet (KD) has been reported to reduce pain and decrease the severity of alcohol use disorder, yet its effects on oxycodone responses remain unknown. KD mice displayed increased oxycodone-induced locomotor activity and enhanced antinociceptive effects of oxycodone, suggesting a dietary effect on opiate sensitivity. Male KD mice exposed to chronic oxycodone exhibited increased naloxone-induced jumps, suggesting a sex-specific effect of diet on opioid withdrawal. Consistent with this, male KD mice self-administered less oxycodone while female KD mice did not differ from controls. Finally, no effect of KD on motivation to obtain oxycodone was observed during a progressive ratio schedule. These data suggest sex-biased effects of KD on responses to opioids that should be considered and potentially leveraged in both clinical pain management and treatment of OUD.

Predictors of Significant Liver Fibrosis in People with Chronic Hepatitis C Who Inject Drugs in the Czech Republic

BACKGROUND AND OBJECTIVES

HCV infection often remains untreated in people who inject drugs (PWID), albeit they may present with advanced liver fibrosis at a young age. We aimed to assess the rate of patients with significant fibrosis in PWID starting anti-HCV therapy and identify the factors associated with severe fibrosis.

METHODS

The cohort of 200 patients was divided into two groups: F0-F2 (N = 154, 77%), patients with liver stiffness measurement (LSM) < 10.0 kPa, and F3-F4 (N = 46, 23%), with LSM ≥ 10.0 kPa, indicating significant liver fibrosis.

RESULTS

In group F3-F4, there were significantly more males, and the patients were older, with a higher BMI. The number of long-term abstaining patients was significantly higher in group F3-F4 compared with group F0-F2, as well as the proportion of patients reporting harmful drinking. Obesity (OR 4.77), long-term abstinence from illicit drugs (OR 4.06), harmful drinking (OR 2.83), and older age (OR 1.17) were significant predictors of advanced fibrosis in PWID starting anti-HCV therapy.

CONCLUSIONS

A quarter of PWID presented with significant liver fibrosis at treatment initiation. Obesity, long-term drug abstinence, harmful drinking, and older age contributed to significant liver fibrosis.

Examination of methadone involved overdoses during the COVID-19 pandemic

BACKGROUND

The US opioid overdose epidemic continues to escalate. The restrictions on methadone availability including take-home dosing were loosened during the COVID-19 pandemic although there have been concerns about the high street value of diverted methadone. This report examined how fatal overdoses involving methadone have changed over the past two-decades including during the pandemic.

METHODS

The CDC's Wide-ranging Online Data for Epidemiologic Research (WONDER) was used to find the unintentional methadone related overdose death rate from 1999 to 2020. Unintentional methadone deaths were defined using the ICD X40-44 codes with only data for methadone (T40.3). Data from the DEA's Automation of Reports and Consolidated Orders System (ARCOS) on methadone overall use, opioid treatment programs use, and pain management use was gathered for all states for 2020 and corrected for population.

RESULTS

There have been dynamic changes over the past two-decades in methadone overdoses. Overdoses increased from 1999 (0.9/million) to 2007 (15.9) and declined until 2019 (6.5). Overdoses in 2020 (9.6) were 48.1% higher than in 2019 (t(50) = 3.05, p < .005). The state level correlations between overall methadone use (r(49) = +0.75, p < .001), and opioid treatment program use (r(49) = +0.77, p < .001) with overdoses were positive, strong, and statistically significant. However, methadone use for pain treatment was not associated with methadone overdoses (r(49) = -0.08).

CONCLUSIONS

Overdoses involving methadone significantly increased by 48.1% in 2020 relative to 2019. Policy changes that were implemented following the COVID-19 pandemic involving methadone take-homes may warrant further study before they are made permanent.