Discussion
OUD
SENSITIVITY
This double-blind, randomized clinical trial compared bupropion SR with placebo as a treatment for cocaine use in persons receiving methadone as treatment for OUD. Incentive delivery was tailored to participant early incentive response during the 6-week double-blind lead-in period. Among enrolled participants, 31% of participants left the trial before becoming eligible for randomization. MITT analyses showed no overarching benefit of bupropion SR compared with placebo when collapsed across incentive conditions. Sensitivity analyses showed that persons who achieved early abstinence (RP group) did not benefit from concurrent bupropion SR treatment but that persons who continued using cocaine after incentives began (AI group) achieved higher levels of abstinence when receiving bupropion SR with incentives vs placebo with incentives. Bupropion SR also produced a persistent effect on abstinence after incentive removal in participants in the AI group. In contrast, participants who were responsive to incentives early in treatment (RP group) did not demonstrate differential abstinence as a function of medication assignment once incentives were tapered, although this may be related to the low rate of cocaine use in that group overall. Together, these data may support further investigations into pharmacotherapy in the context of tailored incentives.This trial was unique in its assessment of combined incentive and pharmacotherapy treatment as a function of early treatment response. Despite evidence that early treatment response was associated with future abstinence,Bupropion SR may enhance the effects of financial incentives in persons who were unable to achieve early abstinence with incentives alone. The percentage of participants who received bupropion SR and achieved complete abstinence during weeks 26 and 30 overall (65% at both time points) was greater than the highest methamphetamine abstinence produced in a prior examination of bupropion SR and naltrexone (16.5%).