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Opioid misuse worsens treatment outcomes in alcohol use disorder

Study findings showed opioid misuse — as well as cannabis and other drug misuse — was associated with heavy and frequent drinking among individuals receiving treatment for alcohol use disorder.

“Few studies have examined the epidemiology of the co-use of alcohol and opioids,” Katie Witkiewitz, PhD, from the department of psychology and the Center on Alcoholism, Substance Abuse, and Addictions at the University of New Mexico, and colleagues wrote in Alcoholism: Clinical and Experimental Research. “It is unclear whether opioid misuse specifically could impact adherence to alcohol medications above and beyond the effects of other drug use.”

To examine the role of opioid misuse in alcohol use disorder treatment outcomes, the investigators performed secondary analyses of the COMBINE study, a randomized clinical trial in which patients were allocated into treatment groups (n = 1,226). These groups consisted of a combination of medical management (up to nine sessions over 16 weeks) and/or combined behavioral intervention sessions (up to 20 over 16 weeks) and medications (acamprosate, naltrexone and/or placebo) or combined behavioral intervention only for the treatment of alcohol dependence.

Witkiewitz and colleagues analyzed the relationships between baseline opioid misuse and cannabis and other drug use with time to first drinking day and time to first heavy drinking day, as well as frequency and intensity of drinking during treatment and at 1-year follow-up. Overall, 70 individuals reported opioid misuse and 542 reported cannabis or other drug use without opioid misuse. In addition, researchers evaluated medication adherence as a mediator.

Participants who misused opioids were almost three times as likely to drink heavily and more frequently at the end of treatment (OR = 2.9; 95% CI, 1.43-5.9) and 1-year after treatment (OR = 2.66; 95% CI, 1.26-5.59). Analysis showed that opioid misuse at baseline significantly predicted the time to first heavy drinking day (OR = 1.38; 95% CI, 1.13-1.64).

People who misused opioids heavily consumed alcohol 48 days earlier in treatment, drank heavily on about 8% more days in the last month of treatment and 13% more days 1 year after treatment, and consumed four more alcoholic beverages per drinking occasion than those without opioid misuse and no other drug use on average, according to the authors. Although participants who reported opioid misuse had the worst outcomes, those who reported using cannabis and other drugs before treatment were also significantly more likely to experience worse outcomes.

The relationship between illicit drug use and alcohol use disorder treatment outcomes was partially mediated by lower medication adherence. According to Witkiewitz and colleagues, opioid, cannabis and other drug use all predicted significantly lower adherence to prescription medications, and lower adherence predicted worse outcomes.

“Given the increasing rates of opioid misuse in the general population and high rates of comorbidity between opioid misuse and [alcohol use disorder], it is critical for future research to examine opioid misuse among [alcohol use disorder] populations,” the authors concluded. “These findings strongly suggest that clinicians treating [alcohol use disorder] should assess opioid misuse and cannabis and other drug use as potential barriers to medication adherence and potential relapse triggers.” – by Savannah Demko

Disclosures: Witkiewitz is a member of the American Society of Clinical Psychopharmacology’s Alcohol Clinical Trials Initiative (ACTIVE), which was supported by AbbVie, Alkermes, Amygdala Neurosciences, Arbor, Ethypharm, Indivior, Lilly, Lundbeck, Otsuka and Pfizer. Please see the study for all other authors’ relevant financial disclosures.