INTRODUCTION: Despite an increasing recognition that long-term pharmacotherapy for opioid use disorder (OUD) is worthwhile, optimal treatment duration remains unclear.
OBJECTIVE: To describe outcomes among participants who received a year-long buprenorphine, followed by any or no pharmacotherapy.
METHODS: Using data from the RECOVER (Remission from Chronic Opioid Use: Studying Environmental and SocioEconomic Factors on Recovery, NCT03604861) observational study, we focused on participants who received 12 buprenorphine extended-release monthly injections (BUP-XR) within an OUD trial and compared their outcomes by whether further pharmacotherapy was ever used during a 12-month observation period. Key 12-month endpoints included abstinence (urine drug screen negative), cravings (Opioid Craving Scale>0), moderate or severe psychological distress (Kessler 6 items≥5), possible significant functional impairment (any Sheehan Disability Scale item≥5), and moderate-to-severe depression (Beck’s Depression Inventory II>20).
RESULTS: Of 212 included participants, 133 received further pharmacotherapy (mean age 45,2, 68.4% male, 53.4% white, 87.2% stably housed at observational baseline) and 79 no further pharmacotherapy (mean age 44.7, 64.6% male, 53.2% white, 83.5% stably housed). At the 12-month observational visit, pharmacotherapy vs. no pharmacotherapy participants were nominally more likely to be abstinent (71.2% vs. 62.3%, P=0.185) but more likely to report cravings (45.2% vs. 28.3%, P=0.046). Similar proportions of pharmacotherapy vs. no pharmacotherapy groups reported psychological distress (44.3% vs. 39.7%, P=0.529), moderate-to-severe depression (13.1% vs. 12.0%, P=0.823) and functional impairment (23.3% vs. 25.3%, P=0.741).
CONCLUSION: After year-long BUP-XR, without further pharmacotherapy, approximately two-thirds of participants appeared able to maintain abstinence. They experienced less craving than their counterparts, indicating less pre-occupation with drug memories and successful avoidance of drug triggers. While abstinence was greater in those reporting pharmacotherapy use, other outcomes were similar across groups; those who receive further pharmacotherapy may be precisely the patients who need it. Further research is warranted to better establish personalized OUD treatment duration strategies.
