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.

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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.

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“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.

This article originally appeared on Clinical Pain Advisor