Impact of baseline methamphetamine/amphetamine use on discontinuation of methadone and buprenorphine/naloxone among people with prescription-type opioid use disorder in Canada

IF 2.5 4区医学 Q2 SUBSTANCE ABUSE

American Journal on Addictions Pub Date : 2024-06-15 DOI:10.1111/ajad.13619

Jenna Langlois BSc, MSc, Nadia Fairbairn MD, MHSc, Didier Jutras-Aswad MD, MSc, Bernard Le Foll MD, MSc, PhD, Ron Lim MD, M. Eugenia Socías MD, MSc

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引用次数: 0

Abstract

Background and Objectives

Although concurrent stimulant use is common among people with opioid use disorder (OUD), there is little evidence on its impacts on opioid agonist therapy (OAT) outcomes. This study sought to determine the impact of baseline methamphetamine/amphetamine use on discontinuation of OAT among individuals with prescription-type OUD (POUD) initiating methadone or buprenorphine/naloxone as part of a pragmatic randomized trial in Canada.

Methods

Secondary analysis of a pan-Canadian pragmatic trial conducted between 2017 and 2020 comparing supervised methadone versus flexible take-home dosing buprenorphine/naloxone models of care. Cox proportional hazard models were used to evaluate the effect of baseline methamphetamine/amphetamine use (measured by urine drug test [UDT]) on two discontinuation outcomes (i.e., assigned OAT discontinuation, any OAT discontinuation).

Results

Two hundred nine (n = 209) participants initiated OAT, of which 96 (45.9%) had positive baseline methamphetamine/amphetamine UDT. Baseline methamphetamine/amphetamine use was associated with shorter median times in assigned OAT (21 vs. 168 days, hazard ratio [aHR] = 2.45, 95% confidence interval [CI] = 1.60–3.76) and any OAT (25 days vs. 168 days, aHR = 2.06, CI = 1.32–3.24). No interaction between methamphetamine/amphetamine and assigned OAT was observed for either outcome (p > .05).

Conclusion and Scientific Significance

This study offers novel insights on the impact of methamphetamine/amphetamine use on OAT outcomes among people with POUD. Methamphetamine/amphetamine use was common and was associated with increased risk of OAT discontinuation. Supplementary interventions, including treatment for stimulant use, are needed to improve retention in OAT and optimize treatment outcomes in this population.

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加拿大处方类阿片使用障碍患者基线使用甲基苯丙胺/苯丙胺对停用美沙酮和丁丙诺啡/纳洛酮的影响。

背景和目的：尽管同时使用兴奋剂在阿片类药物使用障碍（OUD）患者中很常见，但有关其对阿片类药物激动剂治疗（OAT）结果影响的证据却很少。本研究旨在确定基线使用甲基苯丙胺/苯丙胺对作为加拿大实用随机试验一部分开始使用美沙酮或丁丙诺啡/纳洛酮的处方型阿片类药物滥用（POUD）患者中断阿片类激动剂治疗的影响：对 2017 年至 2020 年间开展的泛加拿大实用性试验进行二次分析，比较美沙酮监管模式与灵活的丁丙诺啡/纳洛酮居家服药模式。采用Cox比例危险模型评估基线甲基苯丙胺/苯丙胺使用情况（通过尿液毒品检测[UDT]测量）对两种停药结果（即指定OAT停药、任何OAT停药）的影响：29 名参与者（n = 209）开始服用 OAT，其中 96 人（45.9%）的基线甲基苯丙胺/苯丙胺 UDT 呈阳性。基线甲基苯丙胺/苯丙胺使用与分配的 OAT 中位时间较短（21 天 vs. 168 天，危险比 [aHR] = 2.45，95% 置信区间 [CI] = 1.60-3.76）和任何 OAT（25 天 vs. 168 天，危险比 = 2.06，CI = 1.32-3.24）有关。在甲基苯丙胺/苯丙胺和指定的 OAT 之间没有观察到任何结果的交互作用（P > .05）：本研究就甲基苯丙胺/苯丙胺的使用对POUD患者OAT结果的影响提供了新的见解。使用甲基苯丙胺/安非他明的情况很普遍，而且与OAT中断风险增加有关。需要采取补充性干预措施，包括对兴奋剂使用的治疗，以提高该人群的OAT保留率并优化治疗效果。

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来源期刊

American Journal on Addictions SUBSTANCE ABUSE-

CiteScore

5.00

自引率

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.