Preliminary evidence of different and clinically meaningful opioid withdrawal phenotypes.
Preliminary evidence of different and clinically meaningful opioid withdrawal phenotypes.
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DOI：
10.1111/adb.12680
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发表时间：
2020-01
影响因子：
3.4
通讯作者：
Strain EC
中科院分区：
文献类型：
--
作者：
Dunn KE;Weerts EM;Huhn AS;Schroeder JR;Tompkins DA;Bigelow GE;Strain EC
Opioid use disorder (OUD) is a public health crisis. Differences in opioid withdrawal severity that predict treatment outcome could facilitate the process of matching patients to treatments. This is a secondary analysis of a randomized controlled trial (RCT) that enrolled treatment-seeking primary heroin users (N=89; males=78) into a residential study. Participants maintained on morphine (30mg, SC, QID) underwent a naloxone (0.4mg, IM) challenge session to precipitate withdrawal. Area-under-the-curve (AUC) values from self-reported withdrawal ratings during the challenge session were analyzed using K-means clustering, revealing 2 phenotype groups. Withdrawal and retention from the subsequent 14-day double-blind, double-dummy RCT comparing 3 study medications (clonidine, tramadol-ER, buprenorphine) were evaluated as a function of phenotype. Cluster analyses suggested HIGH (N=37; mean[SD] SOWS-AUC 123.7[65.8]) and LOW (N=52; SOWS-AUC 68.0 [47.7]) withdrawal phenotype groups. HIGH participants were significantly more female and had lower body mass indices than LOW participants; no drug use variables were significant. Regarding RCT outcomes, HIGH phenotype participants were less likely to be retained in the study (p=0.02) and had higher mean self-reported withdrawal (p=0.05) than LOW phenotype participants. A significant interaction in RCT retention was observed between phenotype (p=0.02) and study medication (p<.01). Self-reported withdrawal was significant for phenotype (p=0.02); study medication trended towards significance (p=0.07). Results suggest patients have meaningfully different experiences of opioid withdrawal that may predict differential response to opioid pharmacotherapies during supervised withdrawal. Additional prospective research to replicate and more thoroughly evaluate withdrawal phenotype correlates and sex differences is warranted.
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影响因子：
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