Variation in psychosocial symptom change: A preliminary examination of Veterans in early medication treatment for opioid use disorder

Abstract: Aim: Risk for Medication treatment for Opioid Use Disorder (MOUD) dropout is greatest during early treatment. To optimize MOUD outcomes, it is critical to identify differential sensitivity of opioid withdrawal symptoms to MOUD. This preliminary study, therefore, assessed daily fluctuations in subjective craving, withdrawal, stress, and pain across the first month of MOUD. We hypothesized opioid craving and withdrawal symptoms would be more sensitive than stress or pain to MOUD. Methods: Male Veterans (N=7; M[SD]Age=50.71[16.09],100% White/Non-Hispanic or Latinx) were recruited between December 2021 and October 2022, at VACHS, within 48 hours of induction onto MOUD (buprenorphine or methadone). Participants self-reported intensity in end-of-day brief smartphone surveys (e.g., “How would you rate your overall pain in the past 24 hours from 0 [not at all] to 10 [extremely]?”). Data was analyzed using multilevel models, with symptom intensity predicted by day in treatment, symptom type, and their interaction. Random intercepts were specified according to participant and random slopes permitted across treatment days. Results: Random effects ANOVA’s indicated an ICC of 0.48. Significant effects were identified for symptom type (F[3,567.87]=10.76, p<.001) and the day*symptom type interaction (F[3,567.87]=6.95, p<.001). Examination of parameter estimates, with craving specified as the reference category for symptom groups, indicated significant variation in symptom change across days in treatment. Compared to craving, which decreased at b=-0.12 (p=.009) units per day, pain increased at b=0.13 (p<.001) daily units, and both stress and withdrawal symptoms increased at b=0.07 (p=.020) daily units. Conclusions: During early MOUD treatment, symptoms appear to fluctuate across patients and symptom types. While some symptoms are alleviated (e.g., craving) over time, others are increased (e.g., pain). Though replications in larger samples are required, these results indicate the need for adjunctive interventions for symptoms less responsive to MOUD.

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