This study reported:
- Interim treatment with buprenorphine significantly improved the psychiatric symptoms of people awaiting comprehensive treatment for opioid use disorder (OUD).
- Buprenorphine treatment, even without concurrent psychosocial counseling, may help patients with no, or delayed, access to comprehensive OUD treatment.
The prevalence of opioid use disorder in many parts of the country outstrips the capacity of treatment programs, and many who seek help must wait to be admitted, sometimes for lengthy periods. NIDA-sponsored researchers recently reported that providing waitlisted patients with technology-supported buprenorphine helped them reduce their illicit opioid use during the wait time. The researchers have now found that the treatment also significantly reduced the patients’ psychiatric symptoms, even though no counseling was provided.
Ms. Joanna Streck, Dr. Stacey Sigmon, and colleagues at the University of Vermont developed and tested the interim treatment in a 12-week study. After a 1-week induction onto buprenorphine, 25 patients received the medication to take at home, with their access and dosage closely controlled by a programmable dispensing device. They also received nightly phone calls via an automated interactive voice response system, which prompted them to report their own opioid use and cravings, encouraged them to attend support groups, and provided urgent access to study staff. No psychosocial counseling was provided as part of the interim dosing regimen.
These 25 patients and an equal number in a control group completed standardized assessments for mood and other psychiatric symptoms at study entry and monthly during clinic visits where their urine was tested and progress monitored. At study entry, both groups’ mean scores on the Beck Depression Inventory and Beck Anxiety Inventory were above the cutoff for clinically significant depression and anxiety (see Figure). At each subsequent evaluation, the group receiving buprenorphine reported significantly fewer symptoms compared with study entry, while the control group did not. Similarly, the buprenorphine recipients’ global psychiatric symptoms and scores on the Addiction Severity Index, but not those of the control group, were significantly reduced.
Note: The gray horizontal lines mark cut-off scores indicating clinically significant problem severity warranting intervention.
Text Description of Graphic
"It is exciting that providing just some basic pharmacotherapy and technology-assisted monitoring may attenuate psychiatric distress in this vulnerable group while they await more comprehensive treatment," says Dr. Sigmon. She notes that the prevalence of psychiatric disorders among people with opioid use disorders is "very high." At their entry into this study, 48 percent of the participants reported psychiatric symptoms at levels indicative of clinically significant disorders.
Dr. Sigmon continues, "That triage buprenorphine dosing mitigates psychological distress as well as reduces opioid use provides further support for considering this approach when access to more comprehensive care is delayed or unavailable." She and her colleagues are now conducting a larger trial of the effects of interim buprenorphine treatment on illicit opioid use and psychiatric symptoms over a longer duration, as well as among patients who live in rural, medically underserved geographic areas.
This study was supported by NIH grants DA042790 and DA037385.
Streck, J.M., Ochalek, T.A., Badger, G.J., et al. Interim buprenorphine treatment during delays to comprehensive treatment: Changes in psychiatric symptoms. Experimental and Clinical Psychopharmacology 26(4):403-409, 2018.
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NIDA. (2019, March 27). Interim Buprenorphine Alleviates Psychiatric Symptoms in Waitlisted OUD Patients. Retrieved from https://www.drugabuse.gov/news-events/nida-notes/2019/03/interim-buprenorphine-alleviates-psychiatric-symptoms-in-waitlisted-oud-patients