Christina McAnulty , Gabriel Bastien , Omar Ledjiar , M. Eugenia Socias , Bernard Le Foll , Ron Lim , Didier Jutras-Aswad , for the OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse
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Participants were randomly allocated to buprenorphine/naloxone or methadone models of care. 270 people with prescription-type opioid use disorder were included in analyses. There were 93 women (34.4%) and 2 transgender (0.7%) participants. Most participants were white (67.4%), 45.9% reported unstable living conditions, and 44.8% had psychiatric comorbidities. Generalized linear mixed models followed by mediation analysis estimated the direct effect of treatment group on Timeline Followback-reported next-week opioid use and the indirect effect through past 24-hour opioid craving measured using the Brief Substance Craving Scale at week 2, 6, 10, 14, 18 and 22.</p></div><div><h3>Results</h3><p>Upon mediation analysis, the average direct effect of treatment on opioid use was 0.465 (95 % CI = 0.183 to 0.751, <em>p</em> < 0.001). The average causal mediated effect was 0.144 (95 % CI = 0.021 to 0.110; <em>p</em> < 0.001). Craving accounted for 23.6 % of the effect of treatment on opioid use (<em>p</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>Past 24-hour craving was associated with increased next-week opioid use; however, craving only partially mediated the effect of buprenorphine/naloxone and methadone on next-week opioid use. Research is needed to develop a comprehensive understanding of factors mediating opioid use during opioid agonist therapy.</p></div>","PeriodicalId":7155,"journal":{"name":"Addictive behaviors","volume":null,"pages":null},"PeriodicalIF":3.7000,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mediating effect of craving on the impact of buprenorphine/naloxone and methadone treatment on opioid use: Results from a randomized controlled trial\",\"authors\":\"Christina McAnulty , Gabriel Bastien , Omar Ledjiar , M. Eugenia Socias , Bernard Le Foll , Ron Lim , Didier Jutras-Aswad , for the OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse\",\"doi\":\"10.1016/j.addbeh.2024.108023\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The relationship between opioid craving and opioid use is unclear. We sought to determine to what extent craving mediated the relationship between opioid agonist therapy and changes in opioid use.</p></div><div><h3>Methods</h3><p>Data came from a pragmatic, 24-week, pan-Canadian, multi-centric, open-label, randomized controlled trial comparing flexible buprenorphine/naloxone take-home doses to standard supervised methadone models of care for the treatment of prescription-type opioid use disorder. Participants were randomly allocated to buprenorphine/naloxone or methadone models of care. 270 people with prescription-type opioid use disorder were included in analyses. There were 93 women (34.4%) and 2 transgender (0.7%) participants. Most participants were white (67.4%), 45.9% reported unstable living conditions, and 44.8% had psychiatric comorbidities. Generalized linear mixed models followed by mediation analysis estimated the direct effect of treatment group on Timeline Followback-reported next-week opioid use and the indirect effect through past 24-hour opioid craving measured using the Brief Substance Craving Scale at week 2, 6, 10, 14, 18 and 22.</p></div><div><h3>Results</h3><p>Upon mediation analysis, the average direct effect of treatment on opioid use was 0.465 (95 % CI = 0.183 to 0.751, <em>p</em> < 0.001). The average causal mediated effect was 0.144 (95 % CI = 0.021 to 0.110; <em>p</em> < 0.001). Craving accounted for 23.6 % of the effect of treatment on opioid use (<em>p</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>Past 24-hour craving was associated with increased next-week opioid use; however, craving only partially mediated the effect of buprenorphine/naloxone and methadone on next-week opioid use. 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引用次数: 0
摘要
背景阿片类药物渴求与阿片类药物使用之间的关系尚不清楚。我们试图确定渴求在多大程度上介导了阿片类药物激动剂治疗与阿片类药物使用变化之间的关系。数据来自于一项务实的、为期 24 周的、泛加拿大的、多中心的、开放标签的随机对照试验,该试验比较了灵活的丁丙诺啡/纳洛酮带回家剂量与标准的美沙酮监督护理模式,以治疗处方类阿片类药物使用障碍。参与者被随机分配到丁丙诺啡/纳洛酮或美沙酮护理模式。270 名处方类阿片使用障碍患者被纳入分析。其中女性 93 人(34.4%),变性人 2 人(0.7%)。大多数参与者为白人(67.4%),45.9%的人生活条件不稳定,44.8%的人患有精神疾病。结果经中介分析,治疗对阿片类药物使用的平均直接效应为0.465(95 % CI = 0.183至0.751,p <0.001)。平均因果中介效应为 0.144 (95 % CI = 0.021 to 0.110; p < 0.001)。结论:过去 24 小时的渴求与下周阿片类药物使用量的增加有关;但是,渴求仅部分介导了丁丙诺啡/纳洛酮和美沙酮对下周阿片类药物使用量的影响。要全面了解阿片类激动剂治疗期间阿片类药物使用的中介因素,还需要开展研究。
Mediating effect of craving on the impact of buprenorphine/naloxone and methadone treatment on opioid use: Results from a randomized controlled trial
Background
The relationship between opioid craving and opioid use is unclear. We sought to determine to what extent craving mediated the relationship between opioid agonist therapy and changes in opioid use.
Methods
Data came from a pragmatic, 24-week, pan-Canadian, multi-centric, open-label, randomized controlled trial comparing flexible buprenorphine/naloxone take-home doses to standard supervised methadone models of care for the treatment of prescription-type opioid use disorder. Participants were randomly allocated to buprenorphine/naloxone or methadone models of care. 270 people with prescription-type opioid use disorder were included in analyses. There were 93 women (34.4%) and 2 transgender (0.7%) participants. Most participants were white (67.4%), 45.9% reported unstable living conditions, and 44.8% had psychiatric comorbidities. Generalized linear mixed models followed by mediation analysis estimated the direct effect of treatment group on Timeline Followback-reported next-week opioid use and the indirect effect through past 24-hour opioid craving measured using the Brief Substance Craving Scale at week 2, 6, 10, 14, 18 and 22.
Results
Upon mediation analysis, the average direct effect of treatment on opioid use was 0.465 (95 % CI = 0.183 to 0.751, p < 0.001). The average causal mediated effect was 0.144 (95 % CI = 0.021 to 0.110; p < 0.001). Craving accounted for 23.6 % of the effect of treatment on opioid use (p < 0.001).
Conclusions
Past 24-hour craving was associated with increased next-week opioid use; however, craving only partially mediated the effect of buprenorphine/naloxone and methadone on next-week opioid use. Research is needed to develop a comprehensive understanding of factors mediating opioid use during opioid agonist therapy.
期刊介绍:
Addictive Behaviors is an international peer-reviewed journal publishing high quality human research on addictive behaviors and disorders since 1975. The journal accepts submissions of full-length papers and short communications on substance-related addictions such as the abuse of alcohol, drugs and nicotine, and behavioral addictions involving gambling and technology. We primarily publish behavioral and psychosocial research but our articles span the fields of psychology, sociology, psychiatry, epidemiology, social policy, medicine, pharmacology and neuroscience. While theoretical orientations are diverse, the emphasis of the journal is primarily empirical. That is, sound experimental design combined with valid, reliable assessment and evaluation procedures are a requisite for acceptance. However, innovative and empirically oriented case studies that might encourage new lines of inquiry are accepted as well. Studies that clearly contribute to current knowledge of etiology, prevention, social policy or treatment are given priority. Scholarly commentaries on topical issues, systematic reviews, and mini reviews are encouraged. We especially welcome multimedia papers that incorporate video or audio components to better display methodology or findings.
Studies can also be submitted to Addictive Behaviors? companion title, the open access journal Addictive Behaviors Reports, which has a particular interest in ''non-traditional'', innovative and empirically-oriented research such as negative/null data papers, replication studies, case reports on novel treatments, and cross-cultural research.