Cognitive-behavioral therapy and educational counseling for chronic pain and opioid dependence

s / Drug and Alcohol Dependence 146 (2015) e202–e284 e219 Methods: 90 POD patients received a standard protocol of buprenorphine/naloxone (BUP/NLX) and were assigned to: physician management (PM) alone, consisting of six 10–15min medically focused sessions; PM plus psychologist-delivered CBT (10 sessions over 12 weeks); or PM plus nurse-delivered EC (10 sessions over 12weeks). Primary outcomeswere pain interference, pain intensity, and percentage of opioid-negative urines. Results: The majority were men (68%), Caucasian (89%), and never married (60%). Completion rates (>90%) and PM attendance (mean of 5.6 of 6 planned sessions) did not vary across conditions. There was a significant overall decrease in average pain interference from4.6 at baseline to 3.4 atmonth 3 (p< .05) and a significant interaction between condition and time (p< .05), favoring PM plus CBT or EC over PM alone: The mean (SD) reductions in pain interference (scored on 0–10 scales) in the CBT, EC, and PMalone groups were 1.7 (1.7), 1.4 (1.6), and 0.6 (1.6), respectively. Pain intensity decreased over time (p< .05) but did not differ by group nor was there a significant interaction with group by time. Overall, the proportion of urine samples indicating nonmedical opioid use decreased from100%at baseline to 31% (95%CI 23–40%) atmonth1, 36% (95% CI 27–46%) atmonth 2, and 39% (95% CI 30–50%) atmonth 3. Covarying for nonmedical opioid use during BUP/NLX induction, there was a significant interaction between counseling and time (p< .05): reductions from baseline were sustained in both CBT and EC groups, while nonmedical opioiduse increased in the PM alone group. Conclusions: Our findings support the efficacy of PM enhanced by CBT or EC for patients with POD treated with BUP/NLX. Financial support: NIDA: K23 DA024050, K24 DA00445, and R01 DA024695. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.062 Significantly lower prevalence of psychopathology in Asian compared to non-Asian methadone maintained patients Gavin Bart, Scott Lenz Medicine, Hennepin County Medical Center, Minneapolis, MN, United States Aims: Comorbid psychiatric illness may affect up to 50% of methadone maintained patients. Previous work has not found significant differences in prevalence of psychiatric illness between Caucasian, Hispanic, and African American methadone maintained patients. Little is known about the prevalence of psychopathology in Asian methadone maintained patients. Methods: Hmong and non-Hmong subjects who had been on methadone for at least 2 months were recruited from a single urban methadone clinic. Those who were pregnant, had end stage liver disease, or were taking medications known to interact with methadone were excluded. To determine Axis I psychiatric diagnoses, a trainedmasters level interviewercompleted theStructured Clinical Interview for DSM-IV and subjects also completed the Symptom Checklist-90 (SCL-90) to assess levels of psychopathology.Descriptive statistics using chi-square for categorical variables, t-tests and analysis of variance for continuous variables evaluated differences between ethnicities. Results: 206 subjects mean age 47.2 years (61.7% male) participated. Ethnic distribution was 30.6% Caucasian, 21.4% African American, 9.2% American Indian, Hmong 36.9%. The Hmong were significantly older (56.6 years) and more likely to be male (71.1%). SCL-90 global severity did not differ between groups and methadone dose did not differ between those with normal versus borderline and abnormal scores. The Hmong had more somatization but less interpersonal sensitivity, depression, and paranoid ideation than non-Hmong. Overall the Hmong were less likely to have a DSM-IV diagnosis than non-Hmong (67% versus 29% without). Of those with diagnoses, there was a significantly lower prevalence of anxiety and mood disorder diagnoses but no difference in substance use disorder diagnoses. Conclusions: Asian methadone maintained subjects have a significantly lower prevalence of DSM-IV axis I diagnoses than non-Asian subjects. We have previously documented superior methadone treatment outcome in Hmong, whether this is influenced by the reduced prevalence in comorbid psychiatric illness remains unknown. Financial support: NIH-NIDA K23 DA024663. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.063 Overexpression of miR-495 in nucleus accumbens attenuates cocaine intake on a progressive ratio schedule of reinforcement Ryan M. Bastle1, Robert J. Oliver2, Nathan S. Pentkowski1, Amy S. Gardiner2, Nora I. Perrone-Bizzozero2, Janet L. Neisewander1 1 Arizona State University, Tempe, AZ, United States 2 Univ. New Mexico, Albuquerque, NM, United States Aims: MicroRNAs regulate translation of multiple functionally related genes. We found that the microRNA, miR-495, has several predicted target genes in the Knowledgebase of Addiction-Related Genes database (http://karg.cbi.pku.edu.cn) and is downregulated in the nucleus accumbens (NAc) by acute cocaine administration. Using a lentiviral vector (LV-miR-495) to increasemiR-495 expression in the NAc in drug naive rats, we found an increase inmiR-495 and a corresponding decrease in several predicted targets compared to LV-GFP controls, suggesting that these genes are regulated bymiR-495 in vivo. In this study, we tested the effects of increasing miR-495 expression on cocaine self-administration (SA). Methods: Rats were initially trained to self-administer cocaine (0.75mg/kg/0.1ml) on a fixed ratio (FR) 5 schedule of reinforcement and then were trained to self-administer 4 different doses of cocaine each available for 30min within a given session with a 10min time out between doses. Once stable cocaine SA dose–response functions were established, we infused either LVmiR-495 or LV-GFP into the medial NAc. Testing began 4 days later, including both withinand between-session cocaine SA dose–response tests (0, 0.03, 0.1, 0.3, 1.0mg/kg, IV; FR5) and tests on a progressive ratio (PR) schedule of cocaine reinforcement using two cocaine doses (0.375 and 0.75mg/kg). Results: LV-miR-495 slightly altered the dose–response function for cocaine intake on an FR5 in a manner consistent with a right-ward shift, and produced a more pronounced attenuation of response rates and intake at the high cocaine dose on the PR. Conclusions: Collectively, these findings suggest that miR-495 may regulate expression of genes in the NAc that are involved in motivation for cocaine. Understanding the role of microRNAs in addiction-related changes in gene expression may offer a novel approach to simultaneously normalize a number of genes that are dysregulated in cocaine addicts. Financial support: Supported by DA034097 and DA025992. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.064