Individual-Level Risk Prediction of Return to Use During Opioid Use Disorder Treatment
10/2023
Journal Article
Authors:
Luo, S. X.;
Feaster, D. J.;
Liu, Y.;
Balise, R. R.;
Hu, M. C.;
Bouzoubaa, L.;
Odom, G. J.;
Brandt, L.;
Pan, Y.;
Hser, Y. I.;
VanVeldhuisen, P.;
Castillo, F.;
Calderon, A. R.;
Rotrosen, J.;
Saxon, A. J.;
Weiss, R. D.;
Wall, M.;
Nunes, E. V.
Volume:
81
Pagination:
45-56
Issue:
1
Journal:
JAMA Psychiatry
PMID:
37792357
URL:
https://www.ncbi.nlm.nih.gov/pubmed/37792357
DOI:
10.1001/jamapsychiatry.2023.3596
Keywords:
Adult Male Humans Female Analgesics, Opioid/therapeutic use Heroin/therapeutic use *Opioid-Related Disorders/drug therapy Naltrexone/therapeutic use *Buprenorphine/therapeutic use Narcotic Antagonists/therapeutic use
Abstract:
IMPORTANCE: No existing model allows clinicians to predict whether patients might return to opioid use in the early stages of treatment for opioid use disorder. OBJECTIVE: To develop an individual-level prediction tool for risk of return to use in opioid use disorder. DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model used predictive modeling with individual-level data harmonized in June 1, 2019, to October 1, 2022, from 3 multicenter, pragmatic, randomized clinical trials of at least 12 weeks' duration within the National Institute on Drug Abuse Clinical Trials Network (CTN) performed between 2006 and 2016. The clinical trials covered a variety of treatment settings, including federally licensed treatment sites, physician practices, and inpatient treatment facilities. All 3 trials enrolled adult participants older than 18 years, with broad pragmatic inclusion and few exclusion criteria except for major medical and unstable psychiatric comorbidities. INTERVENTION: All participants received 1 of 3 medications for opioid use disorder: methadone, buprenorphine, or extended-release naltrexone. MAIN OUTCOMES AND MEASURES: Predictive models were developed for return to use, which was defined as 4 consecutive weeks of urine drug screen (UDS) results either missing or positive for nonprescribed opioids by week 12 of treatment. RESULTS: The overall sample included 2199 trial participants (mean [SD] age, 35.3 [10.7] years; 728 women [33.1%] and 1471 men [66.9%]). The final model based on 4 predictors at treatment entry (heroin use days, morphine- and cocaine-positive UDS results, and heroin injection in the past 30 days) yielded an area under the receiver operating characteristic curve (AUROC) of 0.67 (95% CI, 0.62-0.71). Adding UDS in the first 3 treatment weeks improved model performance (AUROC, 0.82; 95% CI, 0.78-0.85). A simplified score (CTN-0094 OUD Return-to-Use Risk Score) provided good clinical risk stratification wherein patients with weekly opioid-negative UDS results in the 3 weeks after treatment initiation had a 13% risk of return to use compared with 85% for those with 3 weeks of opioid-positive or missing UDS results (AUROC, 0.80; 95% CI, 0.76-0.84). CONCLUSIONS AND RELEVANCE: The prediction model described in this study may be a universal risk measure for return to opioid use by treatment week 3. Interventions to prevent return to regular use should focus on this critical early treatment period.
