Sustained Medication Treatment Can Decrease Opioid Addiction

Individuals who are addicted to prescription painkillers reduce their opioid abuse when given sustained treatment with the medication buprenorphine plus naloxone (Suboxone), according to research published in the Archives of General Psychiatry. The study, which was the first randomized large scale clinical trial using a medication for the treatment of prescription opioid abuse, also showed that the addition of intensive opioid dependence counseling provided no added benefit.

“The study suggests that patients addicted to prescription opioid painkillers can be effectively treated in primary care settings using Suboxone,” said Nora D. Volkow, MD, director of the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. “However, once the medication was discontinued, patients had a high rate of relapse. More research is needed to determine how to sustain recovery among patients addicted to opioid medications.”

In the study, lead author Roger Weiss, MD, of Harvard Medical School, and colleagues utilized a two-phase adaptive treatment research design to examine whether the FDA-approved medication Suboxone could help combat the growing problem of opioid abuse.

Suboxone is a combination of buprenorphine, which can reduce opioid craving, and naloxone, which causes withdrawal symptoms in individuals addicted to opioids if Suboxone were taken by a route other than orally, as prescribed. The combination was specifically designed to prevent abuse and diversion of buprenorphine and was one of the first to be eligible for prescribing under the Drug Addiction Treatment Act, which permits specially trained physicians to prescribe certain FDA-approved medications for the treatment of opioid addiction.

Most studies examining treatments for opioid dependence have focused on patients at methadone clinics who are addicted to heroin. Therefore, little data is available on treatment for individuals addicted to prescription painkillers, particularly in the offices of primary care doctors. To address this issue, NIDA’s Clinical Trials Network launched the Prescription Opioid Addiction Treatment Study (POATS) in 2007, which took place at 10 treatment sites around the country.

“Despite the tremendous increase in the prevalence of addiction to prescription painkillers, little research has focused on this patient population,” said Dr. Weiss in a statement. “This is the first large-scale study to examine treatments exclusively for people who were abusing prescription painkiller medications and were treated with buprenorphine-naloxone, which can be prescribed in a physician’s office.”

In the study, more than 600 treatment-seeking outpatients addicted to prescription opioids received Suboxone in combination with brief standard medical management, in which physicians evaluated treatment effectiveness and recommended abstinence and self-help participation. Half of the participants also received varying intensities of addiction counseling as provided by trained substance abuse or mental health professionals.

Results showed that approximately 49% of participants reduced prescription painkiller abuse during extended (at least 12-week) Suboxone treatment. The success rate dropped to 8.6% once Suboxone was discontinued. Reductions in prescription painkiller abuse were seen regardless of whether or not the patient reported suffering chronic pain, and participants who received intensive addiction counseling did not show better outcomes when compared to those who did not receive additional counseling.