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PAINSCAN LITERATURE REVIEW
Issue 1, Volume 4
Addiction Medicine and Relapse Prevention
8 Articles in this Series
Introduction
The Krebs SPACE Trial
Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid and abuse
The influence of anxiety sensitivity on opioid use disorder treatment outcomes.
Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations
The Addiction Patient
What the SUPPORT Act Means for Providers
Inside the NCASA Report: Ending the Opioid Crisis
The role of opioid prescription in incident opioid abuse and dependence among individuals which chronic non-cancer pain

The influence of anxiety sensitivity on opioid use disorder treatment outcomes.

Exp Clin Psychopharmacol.
2019;27(1):64-77.

Given the high rates of relapse among patients with opioid use disorder (OUD), it is crucial to identify modifiable risk factors for negative treatment outcomes. Anxiety sensitivity (AS) is 1 such risk factor that may be associated with negative OUD treatment outcomes. The present study examined the potential impact of AS on the withdrawal process, subsequent treatment engagement, and relapse among individuals with OUD.

Adults undergoing inpatient detoxification (N = 90) completed self-report and researcher-administered questionnaires on Day 4 of a 5-day buprenorphine-assisted detoxification protocol, and 1 month later a follow-up evaluation assessed treatment engagement and relapse. Although 68% of the sample engaged in subsequent treatment, 76% demonstrated poor adherence. Over half the sample (57%) reported opioid relapse 1 month later.

Results revealed that greater AS and younger age predicted greater fear of withdrawal during detoxification. Contrary to the research hypotheses, AS was not a significant predictor of other treatment outcomes; rather, fear of withdrawal and prior number of opioid detoxifications predicted greater subjective withdrawal severity. During detoxification, younger age was related to greater cravings, and being a male was associated with a higher likelihood of receiving prescription anxiolytics. Following detoxification treatment, referral to residential treatment predicted greater treatment engagement, whereas greater opioid craving, number of days in an uncontrolled environment, and any nonopioid substance use postdischarge predicted greater opioid relapse.

Failure to find a relationship between AS and the withdrawal process is potentially a function of the buprenorphine protocol. Overall, findings may have important implications for the treatment of OUD. 

Commentary

The current observational study examined the potential impact of anxiety sensitivity (AS) on the withdrawal process, subsequent treatment engagement, and relapse to opioid use among adults undergoing five-day inpatient buprenorphine-assisted detoxification for opioid use disorder (OUD). At first, I was excited to see what the findings were in this study and their potential use in OUD for prescription medications and medication-assisted treatment (MAT). It is noteworthy that 97% of the participants in this study reported that heroin was their primary opioid of choice, with the remaining 3% indicating a preference for prescription opioid medication. Thus, the findings can not be generalized to the population of persons engaging in prescription opioid misuse. Another eye-opening factoid is OUD treatment as a whole has “favorable,” yet temporary, outcomes, but anywhere from 65% to 83% of individuals in treatment will relapse in one month.

Predictors of negative OUD treatment outcomes have been identified and include younger age, unemployment, and previous treatment history. This study was an attempt to identify a modifiable risk factor, in this case, AS, that can be addressed during the treatment process. Anxiety sensitivity is the fear of anxiety-related sensations that individuals may use opioids to dampen or avoid, which in turn reinforces the opioid use. The study found that high AS and younger age were associated with the fear of opioid withdrawal, but the number of prior opioid detoxifications predicted withdrawal severity. In addition, a referral to residential treatment was the only predictor for subsequent treatment engagement. Furthermore, opioid craving, the number of days in an uncontrolled environment, and other substance use post-discharge were the only predictors of opioid relapse.

The authors attribute the lack of findings supporting their hypotheses to the use of buprenorphine during the detoxification process in 98% of their sample, which may have impacted participants’ cravings and severity of withdrawal symptoms. This is rather disappointing since it appears their intention was to then treat AS with research-supported, behavioral interventions within the inpatient detoxification treatment setting. Further review into this intervention described the treatment as consisting of psychoeducation about anxiety, interoceptive exposure exercises, and skills-training to facilitate willingness. Even though anxiety sensitivity appears to be present and meaningful in the detoxification treatment for OUD, it appears that more work remains to be done to explain its role in the development and maintenance of opioid use disorder.

 

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Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations
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