Opioid Craving Partially Mediates the Effect of Opioid Agonist Treatment on Likelihood of Non-prescribed Opioid Use

Non-prescribed opioid use among people receiving opioid use disorder (OUD) treatment can be risky. Researchers examined the effect of opioid craving on the impact of opioid agonist treatment (OAT) on self-reported non-prescribed opioid use among 270 people randomized to receive either buprenorphine/naloxone or methadone for 24 weeks. Past-24 hour opioid cravings were measured using the Brief Substance Craving Scale (higher scores indicating stronger cravings).

• Participants’ mean age was 39 years; 34 percent were female; 67 percent were White.
• Receipt of buprenorphine/naloxone was associated with 0.6 fewer days per week of non-prescribed opioid use compared with receipt of methadone.
• The mean craving score was 3.86 among participants receiving buprenorphine/naloxone and 5.84 among those receiving methadone.
• The interaction between OAT type and opioid craving was non-significant.
• Opioid cravings partially mediated the effect of OAT on non-prescribed opioid use similarly among both groups (~24 percent).

Comments: Among this cohort of people with OUD, buprenorphine/naloxone receipt was associated with lower levels of craving and fewer days of non-prescribed opioid use than methadone. Cravings were a significant predictor of non-prescribed opioid use among participants in both treatment groups, suggesting that addressing cravings—via medication dose adjustments and/or therapies targeting coping skills—is important for decreasing the risk of non-prescribed opioid use among people receiving OAT.

Carrie Mintz, MD

Reference: McAnulty C, Bastien G, Ledjiar O, et al. Mediating effect of craving on the impact of buprenorphine/naloxone and methadone treatment on opioid use: results from a randomized controlled trial. Addict Behav. 2024;154:108023.