What Factors Help Shape Long-Term Abstinence from Opioids?

  • Rising rates of opioid use disorder (OUD) and overdose deaths have become a public health crisis, with deaths from prescription opioid and heroin use increasing four-fold since 1999 and reaching a record high of more than 42,000 in 2016.

    • The field of substance use disorder treatment generally recognizes that OUD is a chronic disorder, with cycles of use, treatment, relapse, and recovery, often drawn out over many years. Previous research has suggested that maintaining opioid abstinence for at least 5 years substantially increases the likelihood of future stable abstinence, however studies examining opioid use and abstinence have often been limited by short observation periods, making it difficult to pinpoint just what factors might play a role in long-term recovery.

    In order to puzzle out those factors, this study examined data from the NIDA Clinical Trials Network study, “Long-Term Follow-Up of START Patients,” a 5-year follow-up of 699 adults with OUD who had been randomized to either methadone or buprenorphine/naloxone in the original START (“Starting Treatment with Agonist Replacement Therapies”) trial.

    In their follow-up interviews, 232 (33.2%) participants reported that they had achieved 5-year abstinence from heroin. Of that 232, 145 (20.7% of the total) had remained abstinent from both heroin and other opioids.

    Compared to non-abstinent individuals, those in both categories of opioid abstinence (heroin only or both heroin and other opioids) had fewer health and social function problems at the final follow-up.

    Analysis also found that cocaine users and injection drug users were less likely to achieve 5-year heroin abstinence, and Hispanics (vs. whites) and those treated in clinics on the West Coast (vs. East) were less likely to achieve 5-year abstinence from both heroin and other opioids.

    For both abstinence groups, abstinence was positively associated with older age at first opioid use, lower impulsivity, longer duration of treatment for OUD, and greater social support.

    Conclusions: Reducing cocaine use and injection drug use and increasing social support and retention in treatment may help maintain long-term abstinence from opioids among individuals treated with buprenorphine/naloxone or methadone.


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    Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

    Articles were written based on the following published research:

    Zhu Y, et al. Correlates of Long-Term Opioid Abstinence After Randomization to Methadone Versus Buprenorphine/Naloxone in Multi-Site Trial. Journal of Neuroimmune Pharmacology 2018 (in press)