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In Addiction (Abingdon, England)

BACKGROUND AND AIMS : Several reports have documented risk factors for opioid use following treatment discharge, yet few have assessed sex differences, and no study has assessed risk using contemporary machine learning approaches. The goal of the present paper was to inform treatments for opioid use disorder (OUD) by exploring individual factors for each sex that are most strongly associated with opioid use following treatment.

DESIGN : Secondary analysis of Global Appraisal of Individual Needs (GAIN) database with follow-ups at 3, 6, and 12 months post OUD treatment discharge, exploring demographic, psychological, and behavioral variables that predict post-treatment opioid use.

SETTING : 137 treatment sites across the United States.

PARTICIPANTS : Adolescents (26.9%), young adults (40.8%), and adults (32.3%) in treatment for OUD. The sample (N=1,126) was 54.9% male, 66.1% White, 20% Hispanic, 9.8% multi-race/ethnicity, 2.8% African American, and 1.3% other.

MEASUREMENT : Primary outcome was latency to opioid use over 1 year following treatment admission.

RESULTS : For women, regularized Cox regression indicated that greater withdrawal symptoms (HR=1.31), younger age (HR=0.88), prior substance use disorder (SUD) treatment (HR=1.11), and treatment resistance (HR=1.11) presented the largest hazard for post-treatment opioid use, while a random survival forest identified and ranked substance use problems (VI=0.007), criminal justice involvement (VI=0.006), younger age (VI=0.005), and greater withdrawal symptoms (VI=0.004) as the greatest risk factors. For men, Cox regression indicated greater conduct disorder symptoms (HR=1.34), younger age (HR=0.76), and multiple SUDs (HR=1.27) were most strongly associated with post-treatment opioid use, while a random survival forests ranked younger age (VI=0.023), greater conduct disorder symptoms (VI=0.010), having multiple SUDs (VI=0.010), and criminal justice involvement (VI=0.006) as the greatest risk factors.

CONCLUSION : Risk factors for relapse to opioid use following opioid use disorder treatment appear to be, for women, greater substance use problems and withdrawal symptoms and, for men, younger age and histories of conduct disorder and multiple substance use disorder.

Davis Jordan P, Eddie David, Prindle John, Dworkin Emily R, Christie Nina C, Saba Shaddy, DiGuiseppi Graham, Clapp John D, Kelly John F

2021-Jan-06

Adolescents, Machine learning, Opioid use disorder, Opioids, Risk factors, Trauma, Treatment