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Personalized Care in Opioid Use Disorder maintained on Buprenorphine

Published online by Cambridge University Press:  01 September 2022

H. Elarabi ,
J. Marsden ,
H. Alghafri ,
A. Adem  and
A. Lee
H. Elarabi*
Affiliation:
National Rehabilitation Center, Technical Office / Surveillance And Policy, Abu Dhabi, United Arab Emirates
J. Marsden
Affiliation:
King’s College London, Institute Of Psychiatry, Psychology And Neuroscience, London, United Kingdom
H. Alghafri
Affiliation:
National Rehabilitation Center, Nrc, Abu Dhabi, United Arab Emirates
A. Adem
Affiliation:
Khalifa University, Faculty Of Medicine, Abu Dhabi, United Arab Emirates
A. Lee
Affiliation:
University of Aberdeen, Institute Of Applied Health Sciences, Aberdeen, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

Effectiveness of buprenorphine (BUP) is moderated by medication misuse diversion and non-adherence, and poor retention and high cost. Contingency Managment has added benefit to BUP with Take-home doses as the most preferred reward by Opioid Use Disorder patients.

Objectives

Examine the clinical effectiveness of a novel incentivised medication adherence and abstinence monitoring to enable contingent access to increasing BUP take-home doses.Explore associations with opioid use and retention. Contrast characteristics of polysubstance abusers (PSA) and response to BUP, with single opioid users.

Methods

Two-arm, pragmatic, 16-week outpatient RCT of BUP maintenance.Takehome doses were provided as stepped-approach upto 4-weeks contingent of abstinence (UDS) and adherence according to Therapeutic Drug Monitoring-TDM. Primary outcome and secondard outcomes were % negative UDS for opioids anx retention, respectively. -

Results

Opioid % negative UDS was 76.7% (SD 25.0%) in I-AAM versus 63.5% (SD 34.7%) in TAU (13.3%; 95% [CI] 3.2%–23.3%; Cohen’s d 0.44; 95% CI 0.10–0.87). In I-AAM, 40 participants (57.1%) were retained versus 33 (46.4%) in TAU [OR: 1.54; 95% CI 0.79–2.98). PSA (73.7%, n=104) and carisprodol use increases non-fatal overdose (OR) 3.83, 95% CI 1.25 to 11.71) and 5.31, 95% CI 1.92 to 14.65], respectively. Opioid and non-opioid UDS are positively associated. BUP elimination rate (BUP-EL.R) predicts 26.5% to 65% of negative opioid UDS [Beta - 89.95, 95% CIl -154.20 to -25.70, R2 0.22]. Family enagement increases retention by 3-fold.

Conclusions

BUP + incentivised TDM for contingent access to increasing take-home doses increased abstinence. BUP-EL.R seems promising in BUP treatment precision and BUP is clinically valuable in polysubstance abusers.Engaging family enhances retention.

Disclosure

No significant relationships.

Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S818
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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