有非致命性用药过量史者的阿片类激动剂治疗效果:一项务实的泛加拿大随机对照试验的结果。

IF 2.5 4区 医学 Q2 SUBSTANCE ABUSE American Journal on Addictions Pub Date : 2024-08-10 DOI:10.1111/ajad.13635
Hannah Crepeault, Lianping Ti, Paxton Bach, Evan Wood, Didier Jutras-Aswad, Bernard Le Foll, Ron Lim, Maria E Socias
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引用次数: 0

摘要

背景和目的:在使用阿片类药物的人群中,非致命性过量(NFO)病史很常见,但人们对这一高风险亚人群的阿片类激动剂治疗(OAT)结果却知之甚少。本研究的目的是调查丁丙诺啡/纳洛酮和美沙酮对患有阿片类药物使用障碍(OUD)并有NFO病史的患者保持和抑制阿片类药物使用的相对效果:方法:对一项泛加拿大实用性试验进行二次分析,该试验比较了灵活的丁丙诺啡/纳洛酮带回家治疗和美沙酮监督治疗对阿片类药物使用障碍(OUD)和NFO病史患者的效果。采用逻辑回归法考察了OAT对在24周内保留指定或任何OAT的影响,并采用协方差分析法考察了治疗臂之间阿片类药物使用的平均差异:在 272 名随机参与者中,有 155 人(57%)在基线时报告至少服用过一次非阿片类药物。丁丙诺啡/纳洛酮组在指定治疗中的保留率为17.7%,美沙酮组为18.4%(调整赔率[AOR] = 0.54,95% CI:0.17-1.54)。丁丙诺啡/纳洛酮组和美沙酮组在任何 OAT 中的保留率分别为 28% 和 20%(AOR = 1.55,95% CI:0.65-3.78)。调整后的无阿片类药物尿检平均值差异为11.9%,丁丙诺啡/纳洛酮治疗组更胜一筹(95% CI:3.5-20.3;P = .0057):在患有 OUD 并有用药过量史的成年人中,总体保留率较低,但如果考虑到保留任何治疗,则保留率会有所提高。这些研究结果凸显了灵活性和以患者为中心的护理对改善该人群的保留率和其他治疗效果的重要性。
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Opioid agonist treatment outcomes among individuals with a history of nonfatal overdose: Findings from a pragmatic, pan-Canadian, randomized control trial.

Background and objectives: History of nonfatal overdose (NFO) is common among people who use opioids, but little is known about opioid agonist treatment (OAT) outcomes for this high-risk subpopulation. The objective of this study was to investigate the relative effectiveness of buprenorphine/naloxone and methadone on retention and suppression of opioid use among individuals with opioid use disorder (OUD) and history of NFO.

Methods: Secondary analysis of a pan-Canadian pragmatic trial comparing flexible take-home buprenorphine/naloxone and supervised methadone for people with OUD and history of NFO. Logistic regression was used to examine the impact of OAT on retention in the assigned or in any OAT at 24 weeks and analysis of covariance was used to examine the mean difference in opioid use between treatment arms.

Results: Of the 272 randomized participants, 155 (57%) reported at least one NFO at baseline. Retention rates in the assigned treatment were 17.7% in the buprenorphine/naloxone group and 18.4% in the methadone group (adjusted odds ratio [AOR] = 0.54, 95% CI: 0.17-1.54). Rates of retention in any OAT were 28% and 20% in the buprenorphine/naloxone and methadone arms, respectively (AOR = 1.55, 95% CI: 0.65-3.78). There was an 11.9% adjusted mean difference in opioid-free urine drug tests, favoring the buprenorphine/naloxone arm (95% CI: 3.5-20.3; p = .0057).

Conclusions and scientific significance: Among adults with OUD and a history of overdose, overall retention rates were low but improved when retention in any treatment was considered. These findings highlight the importance of flexibility and patient-centered care to improve retention and other treatment outcomes in this population.

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CiteScore
5.00
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0.00%
发文量
118
期刊介绍: The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.
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Correction to "The prevalence and treatment utilization of substance use disorders among Muslims in the United States: A national epidemiological survey". Issue Information Patient-provider interactions about cannabis for therapeutic purposes vary as a function of provider type: A pilot study. Call for Special Issue Papers 2024 AAAP 36th Annual Meeting & Scientific Symposium Save the Date
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