Optimizing Retention, Duration and Discontinuation Strategies for Opioid Use Disorder Pharmacotherapy (RDD) – An ongoing NIDA Clinical Trials Network research study

Chloe Jordan, PhD

McLean Hospital – Research Project Director
Jordan_Chloe poster

Scientific Abstract

Background: Treatment retention in mediations for opioid use disorder (MOUD) remains a major challenge, and it is unclear whether individuals can safely discontinue MOUD. The Clinical Trials Network is conducting a study which aims to test: 1) strategies to improve retention in MOUD, 2) strategies to improve outcomes among stable patients who want to discontinue MOUD; and 3) predictive models to determine characteristics associated with successful MOUD discontinuation.

Methods: 18 sites are conducting this randomized, pragmatic non-blinded study. Retention Phase participants must be seeking MOUD and appropriate for treatment with buprenorphine (BUP) [N = 1,200] or extended-release naltrexone (XR-NTX) [N = 430]. If choosing BUP, participants are randomized to 1) a standard dose of sublingual BUP (SL-BUP) taken daily, 2) a high dose of SL-BUP taken daily, or 3) a once-monthly extended-release injectable form of BUP (XR-BUP). Discontinuation Phase participants must have completed 1 year of BUP or 6 months of XR-NTX treatment, be stable (no opioid, cocaine, methamphetamine or non-prescribed benzodiazepine use and no diagnosed alcohol use disorder for ≥12 weeks), and actively express the desire to stop MOUD. Daily MOUD participants are randomized to taper with SL-BUP or XR-BUP; those on XR-BUP or XR-NTX taper from that medication [total N=500 SL-BUP; 250 XR-BUP; 250 XR-NTX]. In both phases, participants are also randomized to 1) standard Medical Management (MM), or 2) MM + access to technology-based treatment: the Pear-002a app in the Retention Phase, which delivers cognitive-behavioral counseling and contingency management, or the Connections app in the Discontinuation Phase, which includes a menu of community-based features for recovery.

Anticipated Results: In Retention, better outcomes are expected with the high SL-BUP dose and XR-BUP, and with access to the Pear-002a app. In Discontinuation, better outcomes are expected with a transition to XR-BUP, which self-tapers, and with access to the Connections app.

Conclusions: Results from this study will inform future efforts to optimize OUD treatment outcomes and assist people in successfully discontinuing MOUD.

Live Zoom Session – March 9th

research Areas

Authors

Chloe Jordan, PhD, Scott Provost, MM, MSW, Hannah Shapiro, BS, Andrew Peckham1, PhD, Jungjin Kim, MD, Rachel Tester MS, ARPN, Marc Copersino, PhD, ABPP-CP, Roger D. Weiss, MD

Principal Investigator

Roger D. Weiss, MD