Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2023-09-15 DOI:10.1111/add.16334

Canyon Foot, Philip T. Korthuis, Judith I. Tsui, Sean X. Luo, Brian Chan, Ryan R. Cook

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引用次数: 1

Abstract

Aim

The aim of this study was to estimate how ongoing stimulant use affects return to illicit opioid use after initiation onto medication for opioid use disorder (MOUD).

Design

This was a secondary analysis of pooled data from two clinical trials comparing buprenorphine (BUP-NX) and extended-release naltrexone (XR-NTX).

Setting

Thirteen opioid treatment programs and HIV clinics across 10 states in the United States from 2014 to 2019 took part in this study.

Participants

A total of 528 participants who initiated MOUD as part of trial participation were included. Nearly half (49%) were between 30 and 49 years of age, 69% were male and 66% were non-Hispanic White.

Measurements

The primary outcome was first self-reported day of non-prescribed opioid use following MOUD initiation, and the exposure of interest was daily stimulant use (methamphetamine, amphetamines or cocaine). Both were defined using time-line follow-back. Among participants reporting at least 1 day of illicit opioid use, we also examined relapse to ongoing use, defined as (1) 7 days of continuous opioid use or (2) 4 consecutive weeks with self-reported opioid use, one or more positive urine drug screens (UDS) for opioids or one or more missing UDS.

Findings

Forty-seven per cent of participants reported stimulant use following MOUD initiation, 58% returned to illicit opioid use and 66% of those relapsed to ongoing use. Stimulant use was strongly associated with increased risk of misusing opioids after MOUD initiation when measured daily [adjusted hazard ratio (aHR) = 9.23, 95% confidence interval (CI) = 6.80–12.50, P < 0.001] and over a 7-day period (aHR = 1.27 for each additional day, CI = 1.18–1.37, P < 0.001). Using stimulants weekly or more often was associated with increased likelihood of relapse to ongoing opioid use compared with less than weekly or no stimulant use (adjusted odds ratio = 2.30, CI = 1.05–5.39, P = 0.044).

Conclusions

People initiated on medication for opioid use disorder who subsequently use stimulants appear to be more likely to return to and continue using non-prescribed opioids compared with those without stimulant use. The association appears to be stronger among patients who initiate buprenorphine compared with those who initiate extended-release naltrexone.

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在开始使用药物治疗阿片类药物使用障碍后，使用兴奋剂与再次非法使用阿片类药物之间的关系

目的本研究旨在估算在开始接受阿片类药物使用障碍（MOUD）药物治疗后，持续使用兴奋剂对重新非法使用阿片类药物的影响。设计这是对比较丁丙诺啡（BUP-NX）和缓释纳曲酮（XR-NTX）的两项临床试验的汇总数据进行的二次分析。研究背景 2014年至2019年，美国10个州的13个阿片类药物治疗项目和艾滋病诊所参与了这项研究。参与者作为试验参与的一部分，共有 528 名参与者开始接受 MOUD 治疗。近一半（49%）的参与者年龄在 30 至 49 岁之间，69% 为男性，66% 为非西班牙裔白人。测量主要结果是开始使用 MOUD 后自我报告的非处方阿片类药物的首日使用情况，相关暴露是每日使用兴奋剂（甲基苯丙胺、苯丙胺或可卡因）的情况。这两种情况都是通过时间线跟踪来定义的。在报告至少有一天非法使用阿片类药物的参与者中，我们还检查了复发到持续使用的情况，其定义为：（1）连续使用阿片类药物 7 天；或（2）连续 4 周自我报告使用阿片类药物、一次或多次阿片类药物尿液药物筛查（UDS）呈阳性或一次或多次 UDS 缺失。研究结果 47%的参与者报告在开始使用 MOUD 后使用了兴奋剂，58%的人重新开始使用非法阿片类药物，66%的人复发并继续使用。如果每天测量[调整后危险比 (aHR) = 9.23，95% 置信区间 (CI) = 6.80-12.50，P <0.001]，以及在 7 天内测量（每增加一天，危险比 = 1.27，CI = 1.18-1.37，P <0.001），使用兴奋剂与开始使用 MOUD 后滥用阿片类药物的风险增加密切相关。与每周少于一次或不使用兴奋剂相比，每周一次或更频繁地使用兴奋剂与复发持续使用阿片类药物的可能性增加有关（调整后的几率比 = 2.30，CI = 1.05-5.39，P = 0.044）。结论与不使用兴奋剂的患者相比，因阿片类药物使用障碍而开始接受药物治疗但随后使用兴奋剂的患者似乎更有可能恢复并继续使用非处方阿片类药物。与开始使用缓释纳曲酮的患者相比，开始使用丁丙诺啡的患者似乎更容易出现这种情况。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.