Persistence on a stress-challenge task before initiating buprenorphine treatment was associated with successful transition from opioid use to early abstinence

Abstract

Objectives: Lapse to opiate use after initiation of buprenorphine treatment is common and is a strong predictor of poor treatment retention and increased risk of long-term opiate use. Drug cues and situations or events associated with distress are known to provoke craving and increase risk for lapse. This study evaluated the predictive validity of a behavioral index of persistence during a stress challenge among opiate users identified as affectively vulnerable to lapse risk due to elevated depressive symptoms.

Methods: Patients from an ongoing clinical trial (n = 48) completed a stress-challenge task before receiving their first dose of buprenorphine.

Results: After controlling for levels of craving on their induction day, persistence on the stress-challenge task before initiating buprenorphine treatment was associated with successful transition to early abstinence, and lower rates of opiate use during the initial 3 months of buprenorphine treatment across antidepressant and placebo groups.

Conclusions: Results from this preliminary study suggest the promise of laboratory-based behavioral paradigms in facilitating an understanding of important mechanisms of early lapse. Identifying individual behavioral responses to drug and stress cues before attempts at abstinence may facilitate delivery of adjunctive behavioral treatments to prevent early lapse.

Trial registration: ClinicalTrials.gov NCT00475878.

Figures

Figure 1

Predicted probabilities of a positive opiate test assessed during buprenorphine treatment. Although analyzed continuously, we present lines and confidence bands for groupings of Low (25th percentile), Medium (50th percentile), and High (75th percentile) levels of PASAT persistence times. Lower persistence scores were associated with increased probability of positive opiate tests, particularly early after the first dose of buprenorphine and at the end of scheduled treatment when titration strategies were initiated.