Transcript Style D 36 by 54 - CTN Dissemination Library

Gender Differences at Presentation for Treatment-Seeking Opiate
Dependence
2
Wahlquist ,
2
Carter ,
1
Back ,
1
Payne ,
3
Hillhouse
Amy
Rickey
Sudie
Rebecca
Maureen
1Psychiatry and Behavioral Sciences, 2Biostatistics, Bioinformatics, and Epidemiology,
Medical University of South Carolina, Charleston, SC
3Univeristy of California, Los Angeles
Background
Table 1. Demographic characteristics
74%
Ethnicity
Statistical analysis: Wilcoxon rank sum and Pearson chi-square
test statistics were used to test the equality of means and
frequencies, respectively, between men and women at baseline.
92%
0.6
41%
0.3
0.2
N
ico
tin
e
le
tip
al
In
h
M
ul
an
ts
ns
ge
no
al
lu
ci
In
ho
an
a
< .01
.12
H
23.6
24.4
iju
73.6
55.5
M
ar
23.9
23.1
es
67.6
52.7
et
am
in
.05
.08
e
3.7
33.0
in
9.0
65.7
Am
ph
3.9
32.4
Al
co
Withdrawal Symptoms
COWS
ARSW
Subjective Craving
VAS (currently craving opiates)
VAS (current opiate withdrawal symptoms)
oc
a
8.6
61.2
0
C
.02
s
2
p=.97 p=.19
ive
13.1
p<.01
da
t
2.2
p=.25
l
12.8
0.1
Se
.07
p<.01
ra
te
s
SD
9.5
p=.48
p=.05
rb
itu
Mean
34.7
p=.06
p=.01
es
SD
10.7
68%
Female
Male
0.4
Ba
200
p<.01
pi
at
78%
0.5
O
469
p=.51
er
119
%
48%
p=.10
-Il
l
269
< .01
0.5
Substance Use: Substance use comparisons included lifetime and past 30 day use
(Figure 3) and lifetime use. For past 30 day use, more men reported heroin use
(p=.03), but more women reported other opiate (p<.01) and amphetamine (p<.01)
use. For lifetime use, more men reported alcohol (p=.04), marijuana (p<.01), and
multi substance (p=.04) use, while more women reported other opiate (p<.01) and
amphetamine (p<.01) use. Men also reported more past 30 day alcohol use (p=.04),
lifetime alcohol use (p<.01), lifetime alcohol use to intoxication (p=.03), lifetime heroin
use (p<.01), lifetime marijuana use (p<.01), lifetime multi substance use (p<.01), and
lifetime nicotine use (p=.04). Women reported more amphetamine use in past 30
days (p<.01). Based on urine toxicology results, more women had positive results for
amphetamine (p<.01), PCP (p=.02), and methamphetamine (p<.01), while more men
had positive results for marijuana (p=.03).
0.4
Conclusions
{a}categorical variables were compared with Pearson chi-square tests; continuous variables were compared with Wilcoxon ranked sum tests
Abbreviations: SD=standard deviation; COWS=Clinical Opiate Withdrawal Scale; ARSW=Adjective Rating Scale for Withdrawal; VAS=Visual Analog Scale
Demographics: There was a statistically significant difference between men and
women’s race, employment, and education completed. No other significant
differences were noted (Table 1).
Figure 2. ASI-Lite subscale scores
0.6
p<.01
p<.01
Female
0.3
p<.01
p<.01
p<.01
0.2
Male
p=.04
0.1
p<.01
tr i
c
al
ed
ic
M
Le
ga
l
ily
Fa
m
Ps
yc
hi
a
Em
pl
oy
m
en
t
0
Dr
ug
Demographic characteristics, baseline substance use,
withdrawal symptoms, craving, medical history, and other
associated areas of functioning were assessed. A
comprehensive battery of instruments was administered
including the Addiction Severity Index-Lite (ASI-Lite), Adjective
Rating Scale for Withdrawal (ARSW), Clinical Opiate Withdrawal
Scale (COWS), a medical history for past and current physical
health conditions, and a visual analog scale (VAS). The VAS
consisted of two questions at baseline: 1) “How much do you
currently crave opiates?” and 2) “How would you rate your
current opiate withdrawal symptoms?”.
290
Education (years)
co
ho
l
Participants: The participants for this secondary data analysis
were individuals seeking outpatient treatment for opiate
dependence that were screened for CTN-003. Since the current
study aimed to examine
differences at presentation between
Figure 1. Participants
males and females, the only inclusion
criteria to be included in the analysis
were 1) DSM-IV diagnosis of opioid
dependence and 2) a non-missing
gender reported. Two subjects did not
report gender on the baseline
assessment and were excluded from the
analysis. The sample for this analysis
included 892 participants, 293 women
and 599 men (Figure 1).
89%
0.7
.30
Mean
36.4
Al
Methods
534
Age (years)
Mean ASI subscale score
The NIDA-sponsored Clinical Trials Network (CTN) study of
buprenorphine taper schedules was designed to compare the
effects of a short and long taper schedule of buprenorphine on
participant outcomes (CTN-003)1. The study was conducted
from 2003-2005 at 11 participating treatment programs in 10
U.S. cities across the country. A total of 990 individuals agreed
to participant in the trial.
.21
Not Hispanic
Marital Status
Never Married
Employment
Employed
p=.98
0.8
O
th
216
M
td
67%
cr
398
p=.45
-p
re
s
White
p=.03
0.9
M
td
Race
p-value{a}
< .01
in
%
1
er
o
n
Figure 3. Gender differences in percent that reported any use in the past 30 days
H
Variable
Women
n=293
n
%
to
x
Men
n=599
to
Significant gender differences in substance use disorders
have been reported in the literature. Little is known, however,
with regard to gender differences in patients presenting with
opiate dependence.
Results
Al
c
Louise
1
Haynes ,
ASI-Lite: Men had significantly higher alcohol and legal ASI-Lite composite
scores. In contrast, women had significantly higher drug, employment, family,
medical, and psychiatric ASI-Lite composite scores (Figure 2).
Craving and Withdrawal: Women reported significantly higher baseline craving
for opiates based on the VAS. No significant gender differences in opiate
withdrawal symptoms were revealed (Table 1).
Physical Health: Women reported more past and active medical conditions, with
the exception of more men reporting active renal conditions.
Gender-specific profiles among opiate-dependent individuals were observed with
regard to substance use severity, craving, and impairment in associated areas of
functioning. Overall, women demonstrated a more severe clinical profile than men,
as evidenced by significantly higher ASI-Lite subscale scores assessing drug use,
occupational functioning, family and social relationship functioning, medical, and
psychiatric problems. As compared to men, women also had more past and active
medical conditions and reported higher craving for opiates. The findings highlight
the potential usefulness of gender-sensitive assessment and treatment
interventions.
References
1. Ling W, Hillhouse M, Domier C, Doraimani G, Hunter J, Thomas C, Jenkins J, Hasson A, Annon
J, Saxon A, Selzer J, Boverman J, Bilangi R. “Buprenorphine tapering schedule and illicit opioid
use.” Addiction 104(2):256-265 (2009).
Acknowledgements
This study is partially supported by a grant from the National Institute on Drug Abuse (NIDA) CTN SC
grant U10DA013727 (PI: Kathleen Brady). CTN databases and information are available at
www.ctndatashare.org.