The effect of craving on retention and treatment switching under buprenorphine-naloxone and methadone models of care for non-heroin opioid use disorder: Exploratory analyses from a pragmatic, randomized controlled trial

0 PSYCHOLOGY, CLINICAL
Christina McAnulty , Gabriel Bastien , Anita Abboud , Arash Bahremand , Omar Ledjiar , M. Eugenia Socias , Bernard Le Foll , Louis-Christophe Juteau , Didier Jutras-Aswad , for the OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse
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Abstract

Introduction

Though opioid agonist therapies are the mainstay of treatment for opioid use disorder, treatment retention remains suboptimal. Improved prediction of who will remain in treatment could lead to improved treatment outcomes. Whether craving predicts reduced retention in treatment remains debated. We performed analyses to determine whether craving predicted treatment attrition or treatment switching in people with non-heroin opioid use disorder initiating opioid agonist therapy.

Methods

Our data came from the OPTIMA trial - a pan-Canadian, pragmatic, open-label, randomized controlled trial that compared a flexible, early take-home buprenorphine/naloxone model of care (n = 137) to standard treatment with methadone (n = 132) for non-heroin opioid use disorder over a period of 24 weeks. We performed Cox proportional hazards regression to conduct survival analyses of time (days) to treatment attrition, and time to switch to another treatment, with craving as a time-varying covariate, controlling for assigned treatment group, lifetime history of heroin use and province. Craving was measured at baseline, week 2, 6, 10, 14, 18, 22 using the Brief Substance Craving Scale.

Results

We found that craving predicted both treatment drop out and treatment switching. A 1-point increase in craving was associated with a 15.3 % increase of risk of dropping out of the study (HR = 1.153, 95 % CI = 1.065 to 1.248, p < 0.001) and with a 11.5 % increase of risk of switching treatment (HR = 1.115, 95 % CI = 1.016 to 1.225, p = 0.022).

Conclusions

Craving predicted both treatment attrition and treatment switching in people receiving buprenorphine/naloxone or methadone models of care for non-heroin opioid use disorder. These findings highlight the importance of targeting and better addressing craving during treatment with opioid agonist therapies.
在丁丙诺啡-纳洛酮和美沙酮治疗非海洛因阿片类药物使用障碍模式下,渴望对药物保留和治疗转换的影响:一项实用的随机对照试验的探索性分析。
虽然阿片类药物激动剂治疗是治疗阿片类药物使用障碍的主要方法,但治疗保留仍然不是最佳的。改善对谁将继续接受治疗的预测可能会改善治疗结果。渴望是否预示着治疗效果的降低仍有争议。我们进行了分析,以确定在非海洛因阿片类药物使用障碍患者开始阿片类药物激动剂治疗时,渴望是否预测治疗损耗或治疗转换。方法:我们的数据来自OPTIMA试验——一项全加拿大、实用、开放标签、随机对照试验,该试验比较了一种灵活的、早期带回家的丁丙诺啡/纳洛酮护理模式(n = 137)与美沙酮标准治疗(n = 132)在24 周内治疗非海洛因阿片类药物使用障碍。我们进行了Cox比例风险回归,对治疗消耗的时间(天)和切换到另一种治疗的时间进行了生存分析,并将渴望作为一个时变协变量,控制指定治疗组、海洛因使用史和省份。在基线,第2、6、10、14、18、22周,使用简短物质渴望量表测量渴望程度。结果:我们发现渴望预示着治疗退出和治疗转换。渴望每增加1个点,退出研究的风险增加15.3% % (HR = 1.153,95% % CI = 1.065至1.248,p )结论:在接受丁丙诺啡/纳洛酮或美沙酮治疗模式的非海洛因阿片类药物使用障碍的患者中,渴望预测治疗消耗和治疗转换。这些发现强调了在阿片类激动剂治疗期间靶向和更好地解决渴望的重要性。
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来源期刊
Journal of substance use and addiction treatment
Journal of substance use and addiction treatment Biological Psychiatry, Neuroscience (General), Psychiatry and Mental Health, Psychology (General)
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