自述焦虑与阿片类受体激动剂治疗保留率之间的关系:加拿大一项实用性试验的结果。

IF 3.3 3区 医学 Q2 PSYCHIATRY
Anees Bahji, Gabriel Bastien, Paxton Bach, JinCheol Choi, Bernard Le Foll, Ron Lim, Didier Jutras-Aswad, M Eugenia Socias
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引用次数: 0

摘要

背景:处方型阿片类药物使用障碍(POUD)通常伴有焦虑症,但焦虑症对阿片类药物激动剂治疗(OAT)疗效的影响尚不清楚。因此,本研究调查了基线焦虑严重程度是否会影响阿片类受体激动剂疗法的保留率,以及这种影响是否因阿片类受体激动剂疗法的类型(美沙酮维持疗法(MMT)与丁丙诺啡/纳洛酮(BNX))而有所不同:这项二次分析使用了一项泛加拿大随机试验的数据,该试验比较了灵活的居家服药 BNX 和标准监督下的 MMT(为期 24 周)。该研究包括268名患有POUD的成年人。基线焦虑通过贝克焦虑量表(BAI)进行评估,BAI≥16表示中度至重度焦虑。主要结果是在第 24 周时保留指定和任何 OAT。此外,还研究了焦虑严重程度对保留率的影响,并将指定的 OAT 视为效应调节器:参与者中有 176 人(65%)报告了中度至重度基线焦虑。在调整后的分析中,BAI ≥ 16 与 BAI P = 0.07)或任何 OAT(35% vs. 34%;OR = 1.57,95% CI = 0.77-3.21;P = 0.21)之间的保留率没有显著差异。此外,OAT 类型对指定治疗方案的保留率(P = 0.41)或任何 OAT 的保留率(P = 0.71)没有明显的影响。在调整分析中,治疗保持率更高与以下因素有关:BNX(与 MMT 相比)、男性性别身份(与女性、变性人或其他身份相比)、在魁北克研究地点注册(与其他地点相比)以及基线时兴奋剂尿检未呈阳性:结论:基线焦虑严重程度对患有 POUD 的成人继续接受 OAT 治疗的影响不大,OAT 类型也没有明显的影响。然而,总体保留率较低,这说明有必要制定新的策略,最大限度地降低治疗流失的风险:本研究已在ClinicalTrials.gov(NCT03033732)上注册。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Association Between Self-Reported Anxiety and Retention in Opioid Agonist Therapy: Findings From a Canadian Pragmatic Trial.

Background: Prescription-type opioid use disorder (POUD) is often accompanied by comorbid anxiety, yet the impact of anxiety on retention in opioid agonist therapy (OAT) is unclear. Therefore, this study investigated whether baseline anxiety severity affects retention in OAT and whether this effect differs by OAT type (methadone maintenance therapy (MMT) vs. buprenorphine/naloxone (BNX)).

Methods: This secondary analysis used data from a pan-Canadian randomized trial comparing flexible take-home dosing BNX and standard supervised MMT for 24 weeks. The study included 268 adults with POUD. Baseline anxiety was assessed using the Beck Anxiety Inventory (BAI), with BAI ≥ 16 indicating moderate-to-severe anxiety. The primary outcomes were retention in assigned and any OAT at week 24. In addition, the impact of anxiety severity on retention was examined, and assigned OAT was considered an effect modifier.

Results: Of the participants, 176 (65%) reported moderate-to-severe baseline anxiety. In adjusted analyses, there was no significant difference in retention between those with BAI ≥ 16 and those with BAI < 16 assigned (29% vs. 28%; odds ratio (OR) = 2.03, 95% confidence interval (CI) = 0.94-4.40; P = 0.07) or any OAT (35% vs. 34%; OR = 1.57, 95% CI = 0.77-3.21; P = 0.21). In addition, there was no significant effect modification by OAT type for retention in assigned (P = 0.41) or any OAT (P = 0.71). In adjusted analyses, greater retention in treatment was associated with BNX (vs. MMT), male gender identity (vs. female, transgender, or other), enrolment in the Quebec study site (vs. other sites), and absence of a positive urine drug screen for stimulants at baseline.

Conclusions: Baseline anxiety severity did not significantly impact retention in OAT for adults with POUD, and there was no significant effect modification by OAT type. However, the overall retention rates were low, highlighting the need to develop new strategies to minimize the risk of attrition from treatment.

Clinical trial registration: This study was registered in ClinicalTrials.gov (NCT03033732).

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来源期刊
CiteScore
7.00
自引率
2.50%
发文量
69
审稿时长
6-12 weeks
期刊介绍: Established in 1956, The Canadian Journal of Psychiatry (The CJP) has been keeping psychiatrists up-to-date on the latest research for nearly 60 years. The CJP provides a forum for psychiatry and mental health professionals to share their findings with researchers and clinicians. The CJP includes peer-reviewed scientific articles analyzing ongoing developments in Canadian and international psychiatry.
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