Gender Differences at Presentation for Treatment-Seeking Opiate Dependence

1. Gender Differences at Presentation for Treatment-Seeking Opiate Dependence Louise Haynes1, Amy Wahlquist2, Rickey Carter2, Sudie Back1, Rebecca Payne1, Maureen Hillhouse3 1Psychiatry and Behavioral Sciences, 2Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC 3Univeristy of California, Los Angeles Table 1. Demographic characteristics Figure 1. Participants Figure 3. Gender differences in percent that reported any use in the past 30 days p=.03 p=.45 p=.98 p=.10 p=.51 p<.01 p=.06 p=.01 p=.48 p<.01 p=.05 p=.25 p<.01 p=.97 p=.19 Figure 2. ASI-Lite subscale scores p<.01 p<.01 p<.01 p<.01 p<.01 p=.04 p<.01 Background Results 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. 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. Methods 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). 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 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). differences at presentation between 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). Conclusions 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. 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?”. 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. References 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. 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.