Clinical and psychosocial factors affecting outcome with sublingual buprenorphine-naloxone substitution in opioid dependence in terms of abstinence and compliance-A two years longitudinal study

Background

Sublingual buprenorphine-naloxone combination is effective and safe as maintenance therapy in opioid dependence but there is little data to choose the right candidates based on clinical and sociodemographic profiles, often leading to poorer outcomes and relapse. Our study aims to aid clinicians in selecting appropriate candidates for such therapy.

Methods

We conducted a prospective observational study on 106 Opioid-dependent subjects over 5 years where each subject was followed up for 2 years. Sociodemographic profiles, opioid dependence severity, buprenorphine-naloxone dose needed, age at treatment onset, duration of opioid dependence, presence of comorbid Axis I, Axis II disorders, other substance use, and other relevant factors were measured.

Results

Most of the subjects were young adult males with severe dependence. Only 17% remained non-compliant while 18.87% relapsed completely. Buprenorphine-naloxone dose needed was significantly correlated with the severity of dependence. Good compliance with buprenorphine-naloxone predicted less relapse to opioids. Higher buprenorphine-naloxone dose, financial stability, employment and not having problems with primary support group predicted more compliance and abstinence. Being graduate, coexisting mood or anxiety disorders predicted better compliance. Comorbid Axis II disorders, benzodiazepine, or cannabis dependence predicted higher relapse. Ironically, having high perceived criticism was found to be protective against relapse.

Conclusion

Buprenorphine-naloxone therapy has a high rate of long-term compliance even with severe opioid dependence with a relapse rate of less than one in five subjects. Compliance is the biggest predictor of abstinence offering excellent protection against relapse, particularly with optimum dosing of Buprenorphine-naloxone, employment, financial stability, and supportive family.