Buprenorphine-naloxone treatment responses differ between young adults with heroin and prescription opioid use disorders.
Buprenorphine-naloxone treatment responses differ between young adults with heroin and prescription opioid use disorders.
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患有海洛因和处方阿片类药物使用障碍的年轻人对丁丙诺啡-纳洛酮的治疗反应有所不同。
DOI：
10.1111/ajad.12641
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Gonzalez,Gerardo
中科院分区：
文献类型：
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作者：
Romero-Gonzalez,Mauricio;Shahanaghi,Abtin;DiGirolamo,GregoryJ;Gonzalez,Gerardo
背景和目标随着发病率和死亡率的增加，年轻人中阿片类药物使用障碍急剧增加。本研究考察了海洛因 (HU) 和处方阿片类药物 (POU) 使用者对固定剂量丁丙诺啡 - 纳洛酮治疗反应的差异。方法 80 名阿片类药物依赖的年轻人（M=≥22 岁）接受丁丙诺啡 - 纳洛酮 16-4 毫克/天治疗，持续 8 周。使用混合效应回归模型分析 HU (N= 17) 和 POU (N= 63) 在每周阿片类药物使用、阿片类药物渴望、戒断和抑郁症状变化方面的差异。结果 HU 每周阿片类药物使用的总体平均比例为 0.32 (SD = .14)，而 POU 的每周平均比例为 0.24 (SD = .15)显示出显着的主效应（Z= 2.21，p= .02）。两组的抑郁症状（CES-D 评分）在基线时均有所升高（HU：M= 23.1，SD = 11.9；PO：M= 22.2，SD = 9.4），但与 HU 的 18.58 分相比，只有 POU 显着改善至 9.88 分（SD = 7.4） (SD = 10.3) 第 8 周 (Z= 2.24,p= .02)。治疗保留、渴望或戒断症状没有显着差异。讨论和结论在每周使用阿片类药物时，海洛因使用者相对于阿片类处方使用者，对 16-4mg/天丁丙诺啡-纳洛酮的治疗反应显着减弱。海洛因使用者也有持续的抑郁症状，表明需要密切监测。科学意义这些数据表明年轻的海洛因使用者可能需要更高剂量的丁丙诺啡。 （Am J Addict 2017；26：838–844）
Background and ObjectivesOpioid use disorder among young adults is rising sharply with an increase in morbidity and mortality. This study examined differences in treatment response to a fixed dose of buprenorphine‐naloxone between heroin (HU) and prescriptions opioids (POU) users.MethodsEighty opioid dependent young adults (M= 22 years) were treated with buprenorphine‐naloxone 16–4 mg/day for 8 weeks. Differences between HU (N= 17) and POU (N= 63) on changes in weekly opioid use, opioid craving, withdrawal, and depression symptoms were analyzed with mixed‐effects regression models.ResultsThe HU had an overall mean proportion of weekly opioid use of .32 (SD = .14) compared to POU's weekly mean of .24 (SD = .15) showing a significant main effect (Z= 2.21,p= .02). Depressive symptoms (CES‐D scores) were elevated at baseline for both groups (HU:M= 23.1, SD = 11.9; PO:M= 22.2, SD = 9.4), but only POU improved significantly to a score of 9.88 (SD = 7.4) compared to HU's score of 18.58 (SD = 10.3) at week 8 (Z= 2.24,p= .02). There were no significant differences in treatment retention, craving, or withdrawal symptoms.Discussion and ConclusionsTreatment response to 16‐4 mg/day of buprenorphine–naloxone was significantly diminished for heroin users relative to opioid prescription users in weekly opioid use. Heroin users also had persistent depressive symptoms suggesting the need for close monitoring.Scientific SignificanceThese data suggest that young heroin users might require higher doses of buprenorphine. (Am J Addict 2017;26:838–844)