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

Yih-Ing Hser; Yuhui Zhu; Zhe Fei; Larissa J Mooney; Elizabeth A Evans; Annemarie Kelleghan; Abigail Matthews; Caroline Yoo; Andrew J Saxon

doi:10.1111/add.15594

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

Addiction. 2022 Jan;117(1):151-161. doi: 10.1111/add.15594. Epub 2021 Jun 22.

Authors

Yih-Ing Hser¹, Yuhui Zhu¹, Zhe Fei², Larissa J Mooney^{1

3}, Elizabeth A Evans⁴, Annemarie Kelleghan⁵, Abigail Matthews⁶, Caroline Yoo⁷, Andrew J Saxon^{8

9}

Affiliations

¹ Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine, University of California, Los Angeles, USA.
² Department of Biostatistics, University of California, Los Angeles, USA.
³ Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁴ Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, USA.
⁵ Department of Psychology, University of Southern California, Los Angeles, USA.
⁶ Emmes Corporation, Rockville, MD, USA.
⁷ Department of Health Policy and Management at the Fielding School of Public Health, University of California, Los Angeles, CA, USA.
⁸ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, WA, Seattle, USA.
⁹ Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT01592461.

Keywords: Buprenorphine; comorbidity; longitudinal; mental health disorder; methadone; opioid use disorder.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adult
Analgesics, Opioid / therapeutic use
Buprenorphine* / therapeutic use
Buprenorphine, Naloxone Drug Combination / therapeutic use
Follow-Up Studies
Humans
Methadone / therapeutic use
Narcotic Antagonists / therapeutic use
Opiate Substitution Treatment
Opioid-Related Disorders* / drug therapy
Opioid-Related Disorders* / epidemiology

Substances

Analgesics, Opioid
Buprenorphine, Naloxone Drug Combination
Narcotic Antagonists
Buprenorphine
Methadone

Associated data

ClinicalTrials.gov/NCT01592461

Abstract

Publication types

MeSH terms

Substances

Associated data

Grants and funding