In patients receiving opioid substitution treatment for opioid use disorder (mainly involving heroin), those exhibiting a rapid decline in heroin use were found to be more likely to have successful treatment outcomes, according to a study published in Drug and Alcohol Dependence.
A total of 7719 adults patients with opioid use disorder, involving heroin for the majority, who received opioid substitution treatment in England were enrolled in this prospective, observational 7-year study. Investigators used a structured clinical interview at admission and every 6 months to develop distinct heroin use trajectories among the participants, using the number of heroin use days in the 28 days before each interview during the first 5 years.
Trajectory classes for heroin use were gradual decreasing (20.9%), continued low-level (17.0%), continued high-level (14.8%), decreasing then increasing (21.7%), and rapid decreasing (25.6%). The primary outcome measure was successful completion of treatment and no re-presentation, defined as the completion of opioid substitution treatment, opioid use disorder remission, and abstinence from heroin and cocaine.
A total of 4616 patients (60.3%) remained in opioid substitution treatment at the end of the 7-year study period. Completion of treatment with no re-presentation was achieved by 28.8% of patients discharged from the opioid substitution treatment and was found to be more likely at the 5-year follow-up in patients who had exhibited a gradual decreasing (adjusted odds ratio [aOR], 2.40; 95% CI, 1.77-3.26), a continued low-level (aOR, 2.46; 95% CI, 1.78-3.40), and a rapid decreasing (aOR, 3.26; 95% CI, 2.43-4.37) trajectory of heroin use vs maintaining continued high levels. Additional factors associated with treatment completion/no re-presentation included employment at admission (aOR, 1.45; 95% CI, 1.15-1.83) and the use of adjunctive psychosocial therapies (aOR, 1.44; 95% CI, 1.03-2.02).
A limitation of the analysis includes the lack of evaluation of effects associated with attendance of study participants to Narcotics Anonymous.
“The differential association between trajectory membership and subsequent outcomes has real application and could be important to clinicians and treatment purchasers, as it indicates a substantial proportion of patients exhibit chronic or relapsing opioid use in response to treatment and may require more intensive interventions over a longer period,” concluded the study authors.
Eastwood B, Strang J, Marsden J. Continuous opioid substitution treatment over five years: Heroin use trajectories and outcomes. Drug Alcohol Depend. 2018;188:200-208.