Considerations on the role of buprenorphine in recovery from heroin addiction from a UK perspective

Patient and Provider Perspectives on Processes of Engagement in Outpatient Treatment for Opioid Use Disorder: A Scoping Review

Effective treatment for opioid use disorder (OUD) is available, but patient engagement is central to achieving care outcomes. We conducted a scoping review to describe patient and provider-reported strategies that may contribute to patient engagement in outpatient OUD care delivery. We searched PubMed and Scopus for articles reporting patient and/or provider experiences with outpatient OUD care delivery. Analysis included: (1) describing specific engagement strategies, (2) mapping strategies to patient-centered care domains, and (3) identifying themes that characterize the relationship between engagement and patient-centered care. Of 3,222 articles screened, 30 articles met inclusion criteria. Analysis identified 14 actionable strategies that facilitate patient engagement and map to all patient-centered care domains. Seven themes emerged that characterize interpersonal approaches to OUD care engagement. Interpersonal interactions between patients and providers play a pivotal role in encouraging engagement throughout OUD treatment. Future research is needed to further evaluate promising engagement strategies.

Association between dynamic dose increases of buprenorphine for treatment of opioid use disorder and risk of relapse

BACKGROUND AND AIMS

Dynamic, adaptive pharmacologic treatment for opioid use disorder (OUD) has been previously recommended over static dosing to prevent relapse, and is aligned with personalized medicine. However, there has been no quantitative evidence demonstrating its advantage. Our objective was to estimate the extent to which a hypothetical intervention that increased buprenorphine dose in response to opioid use would affect risk of relapse over 24 weeks of follow-up.

DESIGN

A secondary analysis of the buprenorphine arm of an open-label randomized controlled 24-week comparative effectiveness trial, 2014-17.

SETTING

Eight community addiction treatment programs in the United States.

PARTICIPANTS

English-speaking adults with DSM-5 OUD, recruited during inpatient admission (n = 270). Participants were mainly white (65%) and male (72%).

INTERVENTION(S)

Participants were treated with daily sublingual buprenorphine-naloxone (BUP-NX), with dose based on clinical indication, determined by the provider. We examined a hypothetical intervention of increasing dose in response to opioid use.

MEASUREMENTS

Outcome was relapse to regular opioid use during the 24 weeks of outpatient treatment, assessed in a survival framework. We estimated the relapse-free survival curves of participants under a hypothetical (i.e. counterfactual) intervention in which their BUP-NX dosage would be increased following their own subject-specific opioid use during the first 12 weeks of treatment versus a hypothetical intervention in which dose would remain constant.

FINDINGS

We estimated that increasing BUP-NX dose in response to recent opioid use would lower risk of relapse by 19.17 percentage points [95% confidence interval (CI) = -32.17, -6.18) (additive risk)] and 32% (0.68, 95% CI = 0.49, 0.86) (relative risk). The number-needed-to-treat with this intervention to prevent a single relapse is 6.

CONCLUSIONS

In people with opioid use disorder, a hypothetical intervention that increases sublingual buprenorphine-naloxone dose in response to opioid use during the first 12 weeks of treatment appears to reduce risk of relapse over 24 weeks, compared with holding the dose constant after week 2.

Long-lasting effects of adolescent oxycodone exposure on reward-related behavior and gene expression in mice

RATIONALE

Prescription opioid abuse and transition to heroin use are growing problems in the USA. However, the long-term consequences of adolescent prescription opioid abuse on subsequent drug use and affective-like behavior are unknown.

OBJECTIVES

This study aims to determine if adolescent exposure to oxycodone alters the rewarding effects of morphine, anxiety-like behavior, and reward-related gene expression later in adulthood.

METHODS

Adolescent male C57Bl/6 mice were exposed to oxycodone (3 mg/kg/day) via osmotic minipumps for 28 days. Following a 28-day withdrawal period, mice were tested in morphine-conditioned place preference paradigm (CPP), morphine sensitization, open field, marble burying, and forced swim (FST) tests. To determine if effects were specific to adolescent exposure, adult mice were exposed to oxycodone for 28 days and underwent 28 days of withdrawal prior to the same behavioral testing schedule. Expression of reward-related genes including dopamine receptor 1 (D1) and dopamine transporter (DAT) in the nucleus accumbens (NAc) and ventral tegmental area (VTA) was examined.

RESULTS

Adolescent oxycodone exposure significantly increased (300 %) response to morphine CPP during adulthood and significantly reduced D1 expression (30 %) in the NAc and DAT expression (75 %) in the VTA. Adult oxycodone exposure did not affect subsequent responses to morphine CPP. Oxycodone exposure did not affect the development of morphine sensitization or affective-like behaviors. Corticosterone response to a stressor (FST) was significantly reduced (65 %) in mice exposed to oxycodone during adolescence but not adulthood.

CONCLUSIONS

Adolescent oxycodone exposure enhances rewarding effects of morphine in adulthood with no effect on other affective-like behaviors.