Opioid dependence is a chronic, relapsing medical disorder that affects an individual's mood and behavior. Treatment of opioid dependence using pharmacologic interventions to prevent withdrawal, relieve cravings and block or attenuate the euphoric effects of opioids has recently been enhanced with the adoption of buprenorphine/naloxone in primary care office-based medical practices. This proposal will study whether pharmacological treatment of depressive symptoms with selective serotonin reuptake inhibitors (SSRI) at the time of buprenorphine initiation for opioid dependence increases treatment retention among patients treated in office-based settings. The Primary Aims of this proposal are: 1) To perform a randomized, double blind, placebo-controlled trial to determine whether escitalopram treatment of depressive symptoms increases treatment retention among opioid dependent 182 patients initiating office-based buprenorphine treatment. 2) To determine if antidepressant medication treatment reduces depressive symptom scores compared to a placebo condition among office-based buprenorphine treatment recipients. Our theoretical model postulates that an intervention effect on depressive symptoms should mediate buprenorphine treatment dropout. We propose that pharmacotherapy will improve depressive symptoms commonly seen at the time of and after the initiation of buprenorphine therapy and thereby improve the stability of recovery. Our results will have immediate clinical implications for the care of buprenorphine patients receiving office-based opioid dependence treatment. The focus of this study, the evaluation of combinations of medications, to treat substance-related disorders, fits squarely within the emphasis of this RFA. ? ? ?
