Correlation of Illicit Opioid Use With Antidepressants in Adults Receiving Buprenorphine/Naloxone: An Exploratory Analysis

Abstract

Background:

Depression and anxiety are highly prevalent among individuals with opioid use disorder (OUD), and antidepressants are frequently prescribed in conjunction with medication for opioid use disorder. However, the relationship between specific antidepressants and continued illicit opioid use during buprenorphine-based treatment remains insufficiently characterized. This exploratory analysis aimed to investigate the association between prescribed antidepressants and illicit opioid use among adults with OUD receiving buprenorphine/naloxone.

Methods:

This sub-analysis included 92 participants from a randomized controlled trial of 141 adults with OUD treated with buprenorphine/naloxone over 16 weeks in an outpatient setting. Participants were eligible if they received at least one antidepressant for a minimum duration of 10 days. Depressive and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. The primary outcome was the proportion of urine drug screens positive for illicit opioids. Point-biserial correlation analyses were conducted to examine associations between individual antidepressants and illicit opioid use. Antidepressants demonstrating significant associations were subsequently included in multivariable linear regression models adjusted for age, treatment allocation group, and buprenorphine elimination rate constant. Interaction effects were also examined.

Results:

The mean (SD) PHQ-9 score was 10.0 (5.4), and the median (IQR) GAD-7 score was 5.5 (2.0-13.75). Escitalopram 10 mg was the only antidepressant significantly associated with illicit opioid use, demonstrating a negative correlation (r_pb = −.28). Multivariable regression analyses indicated that escitalopram exposure and older age were independently associated with a lower proportion of opioid-positive urine tests. A statistically significant interaction between escitalopram exposure and age was observed.

Conclusions:

Exposure to escitalopram 10 mg was associated with reduced illicit opioid use among individuals receiving buprenorphine/naloxone, with the magnitude of this association modified by age. Further large-scale prospective studies are warranted to confirm these findings and to elucidate the underlying mechanisms.