Substance Misuse

The CTN collaborated with the Division of Pharmacotherapies & Medical Consequences of Drug Abuse (DPMCDA) on this multi-centered trial to compare the effect of buprenorphine/naloxone (Bup/Nx) and methadone (MET) on liver function. This was a randomized, open-label, multi-center, Phase 4 study in participants entering opioid agonist treatment programs at community centers (methadone centers) throughout the country. The study randomized approximately 1,300 participants at 8 sites across 6 Nodes.

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This was a randomized outpatient study for treatment-seeking participants dependent on prescription opioid analgesics. The primary objective was to determine whether the addition of individual drug counseling to the prescription of buprenorphine/naloxone (Bup/Nx) and Standard Medical Management (SMM) improves outcome. Participants were randomized at the beginning of each of two phases to receive BUP/NX paired with either Standard Medical Management (SMM) or Enhanced Medical Management (EMM; defined as SMM plus individual counseling).

Relapse rates are frequently high during the first few months after substance abuse treatment, often reversing many of the positive results of treatment. Virtually all treatment programs strongly recommend that participants get involved in "aftercare" or "continuing care" activities after they are discharged. This study examined the feasibility and potential efficacy of phone calls to patients after discharge from short-term inpatient and residential substance abuse treatment programs to encourage compliance with continuing care plans.

e0ec542cb688b279bf63c83e309eac03 NCT00067171

Women in drug-using communities are one of the fastest growing groups of people with AIDS in the U.S. Female drug users, even if they are in drug treatment, are at especially high risk for heterosexual transmission of HIV: they are often in primary sexual relationships with male drug users, some continue to use drugs despite being in treatment, and, under the influence of drugs (especially cocaine or crack) they are more likely to engage in unprotected sex. It has been shown that drug abuse treatment can reduce activities related to drug use that increase the risk of HIV transmission.

Drug treatment itself can have a powerful positive effect on HIV drug use risk behavior, especially needle use behaviors. However, sexual risk behavior has received less attention and has been shown to be more difficult to change. Research suggests that skills-based HIV risk reduction interventions with peer group discussion and single sex sessions can reduce risky sexual behavior. This study evaluated a five-session HIV risk reduction group therapy designed specifically for men.

HIV-infected patients receiving office-based treatment are more likely to achieve HIV viral suppression, decreasing the overall community viral load and associated HIV incidence. Injection Drug Users are least likely to engage in HIV care and achieve HIV viral suppression compared to other HIV risk groups. Substance abuse treatment can increase engagement in HIV care, but HIV providers have limited options for long-acting office-based addiction treatments. This study will compare extended-release naltrexone to treatment as usual for opioid dependence in HIV-infected patients.

No studies to date have examined the longer-term effects of Suboxone versus methadone after treatment termination. This project will assess the longer-term outcomes of the large sample of opioid-dependent patients randomly assigned, in the START Study (CTN-0027), to receive Suboxone or methadone for a (planned) six to eight months of treatment. The study team will conduct personal interviews of START participants, approximately 3 to 5 years post-admission, supplemented by (electronic) medical and other records as available.

This project will provide novel and critically important tools in artificial intelligence for the detection of substance misuse and COVID-19 from the electronic health record (EHR). Development and validation of a digital classifier would enable a standardized approach to perform screening on all patient encounters on a daily basis in health systems. We will rigorously develop and test the classifier retrospectively on an existing dataset of 60,000 patients who have been screened for COVID-19.

The Population Assessment of Tobacco and Health (PATH) Study is a nationally representative longitudinal study of tobacco use and health in the United States. A collaboration between the National Institute of Health (NIH) National Institute on Drug Abuse (NIDA), and the U.S. Food and Drug Administration (FDA) Center for Tobacco Products, the study was launched in 2011.