SUNY Researcher Wins Young Investigator Award

Anne Neumann, Ph.D., M.A.

Anne Neumann, Ph.D., M.A.

Anne Neumann, Ph.D., M.A., earned the ASAM 2012 Young Investigator Award for research exploring medication-assisted treatments for patients suffering from chronic, non-malignant pain and addiction to prescription opioids, such as hydrocodone and oxycodone. Dr. Neumann, researcher at the State University of New York (SUNY) Primary Care Research Institute, Buffalo, will receive the award during ASAM’s 2012 Awards Luncheon from noon to 2:15 p.m. Saturday in Grand Ballroom East, Ballroom AB.

She will also discuss her research from 3 to 5 p.m. today during Paper Session II, Grand Salon East, Salon A, in her presentation of Paper 7 “A Randomized Controlled Trial Comparing the Long-Term Analgesic Effectiveness of Six Months Buprenorphine and Methadone Treatment in Patients with Chronic Non-malignant Pain and Opioid Addiction.” Her research involves a randomized clinical trial comparing the long-term analgesic effects of six months of treatment with buprenorphine/naloxone (experimental group) or methadone (active comparator) in patients with chronic pain who developed an addiction to their prescription opioids.

“We have a crisis in the United States concerning the abuse and overuse of prescription opioids,” Dr. Neumann says. “Unfortunately, physicians do not receive sufficient training in addiction during medical school. I hope this research will bring awareness to the need to consider medications such as methadone and buprenorphine. Additionally, we conducted this study in an outpatient office setting and therefore, outside a research lab, which I believe will be helpful in translating clinical research into practice.”

While prescribing opioids for chronic, non-malignant pain is common, up to 31 percent of chronic pain patients develop “aberrant medication-taking behavior,” Dr. Neumann says. “Prescription opioids are short-acting and are prescribed for acute pain.”

The standard of care for patients with chronic pain and opioid addiction described by Dr. Neumann involves detoxification from opioids, followed by counseling, abstinence, and treatment of pain with non-opioid medications. However, this is associated with high relapse rates, she notes. Methadone and buprenorphine are better alternatives to prescription opioids in these patients because they are long-acting opioids and replace the short-acting opioids, but don’t result in as much euphoria and abuse.

“Methadone and buprenorphine are effective in treating the separate conditions of chronic pain and addiction,” Dr. Neumann says. “Methadone can have serious side effects, such as potential of drug overdose and respiratory depression. Therefore, buprenorphine possesses a superior safety profile. However, research has not compared the two medications in chronic pain patients identified as having a substance use disorder.”

In her randomized trial, Dr. Neumann notes the primary outcome was analgesia (0- to 10-point scale) at six months. Other outcomes included retention in treatment, retention in the assigned medication group, illicit drug use (by self-report and urine toxicology), functioning, and side effects. She reports that at six months, daily buprenorphine or methadone treatment resulted in significant pain reduction compared to the start of the study. However, the analgesic effects of buprenorphine and methadone treatment did not differ.

Further, participants randomized to methadone reported significantly less use of illicit opioids than participants randomized to buprenorphine at six months, Dr. Neumann says. However, the two groups did not differ in alcohol use, cocaine use, and other drug use. There was no difference in treatment and medication retention, side effects, and functioning among participants randomized to buprenorphine or methadone. Although both daily methadone and buprenorphine treatment produce analgesia after six months of continuous treatment, methadone provides better long-term addiction outcomes than buprenorphine in chronic pain patients with coexistent opioid dependence.

“Unfortunately, most people will relapse after opioid detoxification, mostly because they have chronic pain,” Dr. Neumann says. “Methadone and buprenorphine are viable options because they reduce pain, but don’t produce the same degree of compulsive drug-taking behaviors compared to opioids. I hope that research will help physicians increase their knowledge about the epidemiology of addiction to prescription opioids in chronic pain patients, better understand treatment options for pain and addiction in these patients, and understand the research of the current study and implications of this study for addiction and pain management.”

ASAM’s Young Investigator Award is presented annually during the Society’s Medical Scientific Conference to a paper’s first author who is within five years of the completion of a medical residency or receipt of a doctoral degree.