阿片类药物使用障碍患者使用丁丙诺啡或美沙酮的时间与非处方阿片类药物使用之间的关系:一项队列研究。

Xinyi Jiang, Gery P Guy, Jill A Dever, John S Richardson, Laura J Dunlap, Didier Turcios, Sara Beth Wolicki, Mark J Edlund, Jan L Losby
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引用次数: 0

摘要

背景:在美国,阿片类药物使用障碍(OUD)每年影响数百万人。阿片类药物使用障碍(MOUD)治疗的患者保留率并不理想。本研究对丁丙诺啡或美沙酮每多使用一个月与非处方阿片类药物使用之间的关系进行了研究和量化:数据来自一项为期 18 个月的纵向观察性队列研究,研究对象为接受 OUD 治疗的患者(年龄≥ 18 岁)。患者在2018年3月至2019年12月期间填写了基线自我报告问卷,并被要求在基线后约3、6、12和18个月时填写随访问卷,直至2021年5月。基线前至少 12 个月接受丁丙诺啡或美沙酮治疗且未服用其他 MOUD 的患者也被纳入其中。研究结果包括过去 30 天内非医疗使用处方类阿片、海洛因或非法制造的芬太尼的情况。采用二项分布和对数链接的多变量、多层次回归模型来估计调整后的几率比(aORs)和 95% 置信区间(CIs):该研究包括353名服用丁丙诺啡的患者(平均[标准差]年龄39[11]岁;226[64%]名女性)和785名服用美沙酮的患者(平均[标准差]年龄42[12]岁;392[50%]名女性)。服用丁丙诺啡的患者每多接受一个月的 MOUD 治疗,其过去 30 天非处方阿片类药物使用的几率就会降低 25%(aOR [95% CI] = 0.75 [0.68-0.83]),服用美沙酮的患者则会降低 17%(aOR = 0.83 [0.79-0.87])。COVID-19大流行(aOR = 9.29 [2.96-29.17];aOR = 3.19 [1.74-5.86])和MOUD不良反应经历(aOR = 3.07 [1.11-8.48];aOR = 2.51 [1.01-6.22])与丁丙诺啡组和美沙酮组中较高的非处方阿片类药物使用几率显著相关:在接受丁丙诺啡或美沙酮治疗的患者中,自基线起每增加一个治疗月,那些继续接受治疗的患者似乎更有可能报告过去 30 天内非处方阿片类药物使用的几率下降了 17% 至 25%。我们的研究结果可供临床医生在与患者共同决策的过程中使用,强调了持续接受 MOUD 治疗的价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association Between Length of Buprenorphine or Methadone Use and Nonprescribed Opioid Use Among Individuals with Opioid Use Disorder: A Cohort Study.

Background: Opioid use disorder (OUD) affects millions of individuals each year in the United States. Patient retention in medications for opioid use disorder (MOUD) treatment is suboptimal. This study examines and quantifies the associations between each additional month of buprenorphine or methadone use and nonprescribed opioid use.

Methods: Data were obtained from an 18-month longitudinal, observational cohort study of patients (age ≥ 18 years) treated for OUD. Patients completed a baseline self-reported questionnaire between March 2018 and December 2019 and were asked to complete follow-up questionnaires at approximately 3-, 6-, 12-, and 18-months post-baseline until May 2021. Patients treated with buprenorphine or methadone, without taking other MOUD at least 12 months prior to baseline, were included. Outcomes included past 30-day use of prescription opioids nonmedically, heroin, or illegally made fentanyl. A multivariable, multilevel regression model with a binomial distribution and a logit link was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: This study included 353 patients taking buprenorphine (mean [standard deviation, SD] age 39 [11] years; 226 [64%] female), and 785 patients taking methadone (mean [SD] age 42 [12] years; 392 [50%] female). Each additional month of MOUD treatment was associated with a 25% decrease in the odds of past 30-day nonprescribed opioid use for patients taking buprenorphine (aOR [95% CI] = 0.75 [0.68-0.83]), and a 17% decrease for patients taking methadone (aOR = 0.83 [0.79-0.87]). The COVID-19 pandemic (aOR = 9.29 [2.96-29.17]; aOR = 3.19 [1.74-5.86]) and MOUD adverse reaction experiences (aOR = 3.07 [1.11-8.48]; aOR = 2.51 [1.01-6.22]) were significantly associated with higher odds of nonprescribed opioid use among buprenorphine and methadone groups.

Conclusion: Among patients treated with buprenorphine or methadone, with each additional treatment month since baseline, those who continued with treatment appeared to be more likely to report 17% to 25% decreased odds of past 30-day nonprescribed opioid use. Our findings can be used by clinicians in the shared decision-making process with patients, emphasizing the value of sustained retention in MOUD.

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