• Thomas F Northrup, Angela L Stotts, Charles Green, Jennifer S Potter, Elise N Marino, Robrina Walker, Roger D Weiss, and Madhukar Trivedi.
• Department of Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin Street, JJL 324, Houston, TX 77030, USA. Electronic address: Thomas.f.northrup@uth.tmc.edu.
• Addict Behav. 2015 Feb 1; 41: 20-8.

IntroductionMost patients relapse to opioids within one month of opioid agonist detoxification, making the antecedents and parallel processes of first use critical for investigation. Craving and withdrawal are often studied in relationship to opioid outcomes, and a novel analytic strategy applied to these two phenomena may indicate targeted intervention strategies.MethodsSpecifically, this secondary data analysis of the Prescription Opioid Addiction Treatment Study used a discrete-time mixture analysis with time-to-first opioid use (survival) simultaneously predicted by craving and withdrawal growth trajectories. This analysis characterized heterogeneity among prescription opioid-dependent individuals (N=653) into latent classes (i.e., latent class analysis [LCA]) during and after buprenorphine/naloxone stabilization and taper.ResultsA 4-latent class solution was selected for overall model fit and clinical parsimony. In order of shortest to longest time-to-first use, the 4 classes were characterized as 1) high craving and withdrawal, 2) intermediate craving and withdrawal, 3) high initial craving with low craving and withdrawal trajectories and 4) a low initial craving with low craving and withdrawal trajectories. Odds ratio calculations showed statistically significant differences in time-to-first use across classes.ConclusionsGenerally, participants with lower baseline levels and greater decreases in craving and withdrawal during stabilization combined with slower craving and withdrawal rebound during buprenorphine taper remained opioid-free longer. This exploratory work expanded on the importance of monitoring craving and withdrawal during buprenorphine induction, stabilization, and taper. Future research may allow individually tailored and timely interventions to be developed to extend time-to-first opioid use.Copyright © 2014 Elsevier Ltd. All rights reserved.

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