This week reveals new insight into opioid abuse treatment, a pair of intriguing case reports, and the power of video habit reversal training.
A Red Flag for Buprenorphine Care
Even minimal opioid use in the first weeks of buprenorphine treatment could mean that things aren’t going to go well.
In a new analysis published in The Journal of Clinical Psychiatry, researchers report that even a single day of opioid use in the first two weeks of buprenorphine treatment for opioid use disorder (OUD) can drive up the risk of relapse, fewer opioid-free weeks, and earlier dropout from care.
Researchers gathered data from a pair of randomized clinical trials that included 562 adults receiving buprenorphine between 2006 and 2011. Investigators then tracked self-reported opioid use during the first month of treatment and looked at how early use influenced outcomes.
Two clear thresholds revealed themselves. Any opioid use in the first two weeks (and two or more days of use in the first three weeks) strongly predicted sustained opioid use during weeks five through 12. Patients who crossed the two-week threshold were more than six times as likely to return to sustained opioid use. Those who exceeded the three-week mark faced more than sevenfold higher odds.
Early nonresponse also suggested a link to three to four fewer opioid-free weeks and shorter buprenorphine retention.
Crucially, the findings suggest that even low-frequency use – not just persistent or daily use – can mark early treatment risk. Patients who limited use to a single isolated day fared better. Their return to abstinence hints that rapid course correction could still change outcomes.
The authors argue that these simple thresholds could help clinicians identify patients who need closer monitoring or early treatment adjustments. Those adjustments could include dose changes, extended-release formulations, or added behavioral support. Emphasizing abstinence (or the next-best thing) early in buprenorphine treatment, they conclude, could be critical for long-term stability.
IN OTHER PSYCHIATRY AND NEUROLOGY NEWS
- A new Primary Care Companion for CNS Disorders case report details a 16-year-old boy who experienced catatonia associated with lysergic acid diethylamide use.
- JCP research demonstrates that therapist-delivered video habit reversal training produced large, durable reductions in hair-pulling and skin-picking symptoms in a real-world clinical setting
- Another PCC case study discusses a 39-year-old woman with profound intellectual disability and delayed developmental milestones presented with late-onset severe dermatillomania.
- Original JCP research found that between 2012 and 2024, FDA approvals in psychiatry delivered few true breakthroughs, with most new drugs offering only incremental innovation.
- And, finally, check in with the latest JCP Podcast. Our host Ben Everett, PhD, goes “Behind the Manuscript” with David Feifel, MD, PhD, to discuss the latest changes in mental health care.
