Clinical and psychosocial factors affecting outcome with sublingual buprenorphine-naloxone substitution in opioid dependence in terms of abstinence and compliance-A two years longitudinal study

Sourav Das , Sreetama Chatterjee , Aniket Mukherjee , Divyashree Sah
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Abstract

Background

Sublingual buprenorphine-naloxone combination is effective and safe as maintenance therapy in opioid dependence but there is little data to choose the right candidates based on clinical and sociodemographic profiles, often leading to poorer outcomes and relapse. Our study aims to aid clinicians in selecting appropriate candidates for such therapy.

Methods

We conducted a prospective observational study on 106 Opioid-dependent subjects over 5 years where each subject was followed up for 2 years. Sociodemographic profiles, opioid dependence severity, buprenorphine-naloxone dose needed, age at treatment onset, duration of opioid dependence, presence of comorbid Axis I, Axis II disorders, other substance use, and other relevant factors were measured.

Results

Most of the subjects were young adult males with severe dependence. Only 17% remained non-compliant while 18.87% relapsed completely. Buprenorphine-naloxone dose needed was significantly correlated with the severity of dependence. Good compliance with buprenorphine-naloxone predicted less relapse to opioids. Higher buprenorphine-naloxone dose, financial stability, employment and not having problems with primary support group predicted more compliance and abstinence. Being graduate, coexisting mood or anxiety disorders predicted better compliance. Comorbid Axis II disorders, benzodiazepine, or cannabis dependence predicted higher relapse. Ironically, having high perceived criticism was found to be protective against relapse.

Conclusion

Buprenorphine-naloxone therapy has a high rate of long-term compliance even with severe opioid dependence with a relapse rate of less than one in five subjects. Compliance is the biggest predictor of abstinence offering excellent protection against relapse, particularly with optimum dosing of Buprenorphine-naloxone, employment, financial stability, and supportive family.

影响丁丙诺啡-纳洛酮舌下替代治疗阿片类药物依赖在戒断和依从性方面效果的临床和社会心理因素--一项为期两年的纵向研究
背景舌下丁丙诺啡-纳洛酮复方制剂作为阿片类药物依赖的维持疗法既有效又安全,但根据临床和社会人口学特征选择合适人选的数据却很少,这往往会导致较差的疗效和复发。我们的研究旨在帮助临床医生选择接受此类治疗的合适人选。方法我们对 106 名阿片类药物依赖者进行了一项为期 5 年的前瞻性观察研究,并对每位受试者进行了为期 2 年的随访。对社会人口学特征、阿片类药物依赖严重程度、所需丁丙诺啡-纳洛酮剂量、开始治疗时的年龄、阿片类药物依赖持续时间、是否合并轴I、轴II障碍、其他药物使用以及其他相关因素进行了测量。只有 17% 的受试者仍未遵从医嘱,而 18.87% 的受试者则完全复吸。丁丙诺啡-纳洛酮所需剂量与依赖的严重程度显著相关。丁丙诺啡-纳洛酮依从性好,则阿片类药物复吸率低。较高的丁丙诺啡-纳洛酮剂量、经济稳定、就业以及与主要支持群体没有问题,都预示着更高的依从性和戒断率。如果是毕业生,同时患有情绪或焦虑症,则依从性会更好。合并轴 II 疾病、苯二氮卓类药物或大麻依赖则预示着更高的复发率。具有讽刺意味的是,人们发现高感知批评对复发具有保护作用。结论丁丙诺啡-纳洛酮疗法的长期依从性很高,即使是严重阿片类药物依赖者,复发率也低于五分之一。依从性是戒断的最大预测因素,可有效防止复发,尤其是在最佳丁丙诺啡-纳洛酮剂量、就业、经济稳定和家庭支持的情况下。
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CiteScore
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