Long-term follow-up assessment of opioid use outcomes among individuals with comorbid mental disorders and opioid use disorder treated with buprenorphine or methadone in a randomized clinical trial

AIMS

To investigate whether reduction in opioid use differs when treated by either buprenorphine-naloxone (BUP) or methadone (MET) among adults with comorbid opioid use disorder (OUD) and mental disorders.

DESIGN, SETTING AND PARTICIPANTS

In a randomized controlled trial, adults with OUD were randomized to 24 weeks of either BUP or MET treatment and were followed up in 3-yearly assessments. The present secondary analyses were based on 597 participants who completed all assessments.

MEASUREMENTS

The outcome measure was the number of days of using opioids per month during the follow-up period. The Mini-International Neuropsychiatric Interview (MINI) was used to classify participants into three groups: life-time mood disorder (n = 302), life-time mental disorder other than mood disorder (n = 114) and no mental disorder (n = 181). Medication treatment (BUP, MET, no treatment) during the follow-up period was a time-varying predictor.

FINDINGS

Based on zero-inflated Poisson (ZIP) mixed regression analysis, it was found that relative to no treatment, opioid use during the follow-up was significantly reduced by BUP [odds ratio (OR) = 0.12, 95% confidence interval (CI) = 0.07-0.21 for any use; risk ratio (RR) = 0.77, 95% CI =0.66-0.89 for days of use] and by MET [OR = 0.33, 95% CI = 0.25-0.45 for any use; RR = 0.78, 95% CI = 0.72-0.84 for days of use]. Relative to MET, BUP was associated with a lower likelihood of any opioid use among participants with mood disorders (OR = 0.52, 95% CI = 0.36-0.74) and for participants without mental disorder (OR = 0.37, 95% CI = 0.21-0.66) and fewer number of days using opioids (RR = 0.37, 95% CI = 0.25-0.56) among participants with other mental disorders.

CONCLUSIONS

Among adults with comorbid opioid use disorder and mental disorders, treatment with buprenorphine-naloxone produced greater reductions in opioid use than treatment with methadone.

Prospective Association of Digital Media Use with Alcohol Use Initiation and Progression Among Adolescents

BACKGROUND

Although adolescents commonly use digital media and consume alcohol , longitudinal evidence of the association between these behaviors is scant. This study examined the association between the frequency of digital media use and the subsequent initiation or progression of alcohol use. We also examined whether these associations were moderated by gender and race/ethnicity.

METHODS

The study included 2,473 adolescents from a prospective cohort in the Los Angeles, CA area who were surveyed in fall 2015 (11th grade, baseline for the current study) and every 6 months through the end of high school (Spring 2017, 12th grade). At baseline, youth self-reported the total number of 14 digital media activities (e.g., checking social media, streaming music/videos, texting) they engaged in at a high frequency (i.e., many times a day) over the past week. Scores ranged from 0 (i.e., no reported high-frequency digital media use) to 14 (i.e., reported engagement in all 14 digital media activities at a high frequency). Self-report measures of ever using alcohol, number of days of alcohol use in the past 30 days (0 to 30), binge drinking (yes/no), and covariates (i.e., demographics and measures of behavioral health and other substance use) were assessed at each time point.

RESULTS

Among respondents who at baseline reported never using alcohol (n = 1,214), high-frequency engagement in each additional digital media activity was associated with 4% higher odds of initiating alcohol use (aOR = 1.04, 95% CI: 1.01 to 1.07) across follow-up. Among respondents who at baseline reported ever using alcohol (n = 1,259), baseline high-frequency engagement in each additional digital media activity was associated at follow-up with 3% more days of alcohol use in the past 30 days (aIRR = 1.03, 95% CI: 1.00 to 1.06). Digital media use and binge drinking were not statistically significantly associated at follow-up. There was no evidence of moderation by gender or race/ethnicity.

CONCLUSIONS

Digital media use frequency was modestly associated with increased risk of initiation and progression of alcohol use in adolescence. Additional research is needed to determine potential mechanisms for these associations.