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. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
1R01DA022207-01
Application #
7173083
Study Section
Special Emphasis Panel (ZDA1-MXS-M (02))
Program Officer
Montoya, Ivan
Project Start
2006-09-25
Project End
2009-05-31
Budget Start
2006-09-25
Budget End
2007-05-31
Support Year
1
Fiscal Year
2006
Total Cost
$375,047
Indirect Cost
Name
Rhode Island Hospital
Department
Type
DUNS #
075710996
City
Providence
State
RI
Country
United States
Zip Code
02903
Tsui, Judith I; Anderson, Bradley J; Strong, David R et al. (2014) Craving predicts opioid use in opioid-dependent patients initiating buprenorphine treatment: a longitudinal study. Am J Drug Alcohol Abuse 40:163-9
Cioe, Patricia A; Anderson, Bradley J; Stein, Michael D (2013) Change in symptoms of erectile dysfunction in depressed men initiating buprenorphine therapy. J Subst Abuse Treat 45:451-6
Strong, David R; Brown, Richard A; Sims, Meredith et al. (2012) Persistence on a stress-challenge task before initiating buprenorphine treatment was associated with successful transition from opioid use to early abstinence. J Addict Med 6:219-25
Tsui, Judith I; Herman, Debra S; Kettavong, Malyna et al. (2011) Escitalopram is associated with reductions in pain severity and pain interference in opioid dependent patients with depressive symptoms. Pain 152:2640-4
Tsui, Judith I; Herman, Debra S; Kettavong, Malyna et al. (2011) Chronic pain and hepatitis C virus infection in opioid dependent injection drug users. J Addict Dis 30:91-7
Stein, Michael D; Herman, Debra S; Kettavong, Malyna et al. (2010) Antidepressant treatment does not improve buprenorphine retention among opioid-dependent persons. J Subst Abuse Treat 39:157-66
Tsui, Judith I; Herman, Debra S; Kettavong, Malyna et al. (2010) Physician introduction to opioids for pain among patients with opioid dependence and depressive symptoms. J Subst Abuse Treat 39:378-83