Factors associated with retention on medications for opioid use disorder among a cohort of adults seeking treatment in the community.
Factors associated with retention on medications for opioid use disorder among a cohort of adults seeking treatment in the community.
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在社区寻求治疗的成年人队列中，与阿片类药物使用障碍药物保留相关的因素
DOI：
10.1186/s13722-022-00299-1
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发表时间：
2022-03-07
影响因子：
3.7
通讯作者：
Springer SA
中科院分区：
文献类型：
--
作者：
Biondi BE;Vander Wyk B;Schlossberg EF;Shaw A;Springer SA
阿片使用障碍(OUD)的药物治疗(Moud；丁丙诺啡和美沙酮)减少阿片类药物的使用和过量。停用Moud会很快导致复发、服药过量和死亡。很少有发起MOD的人在治疗中被保留，因此确定与保留相关的因素是至关重要的。评估数据来自一项正在进行的前瞻性队列研究，该研究对18岁或18岁以上的成年人进行了DSM-5中重度OUD在社区寻求Moud，并对其进行了6个月的跟踪调查。如果参与者报告在每次研究面试中没有中断地服用Moud，则被认为保留了Moud 6个月。大剂量的莫德被定义为美沙酮剂量 >； 85 mg或丁丙诺啡剂量 ≥ 16 mg。采用多变量Logistic回归来评估与6个月Moud保留相关的因素。共有118名参与者(73%的男性，58%的白人，36%的艾滋病毒携带者)被纳入其中。58%使用丁丙诺啡，42%使用美沙酮。在6个月时，丁丙诺啡和美沙酮的MUN保留率分别为49%和58%。在调整后的模型中，较高的MOUD剂量(OR = 4.71，95%CI 2.05~10.84)和较高的疼痛干扰(OR = 1.59，95%CI 1.15~2.19)与MOD保留相关。适量的Moud可提高Moud的保留率。此外，基线时疼痛干扰程度高的人在MOUD上保留的几率更高。美沙酮和丁丙诺啡都有止痛作用，因此，疼痛干扰程度高的患者可能具有Moud治疗OUD和疼痛的双重益处。干预措施应该量身定制，以改善足够的Moud剂量，以改善Moud的滞留。
Medication treatment for opioid use disorder (OUD) (MOUD; buprenorphine and methadone) reduces opioid use and overdose. Discontinuation of MOUD can quickly lead to relapse, overdose and death. Few persons who initiate MOUD are retained on treatment, thus it is critical to identify factors associated with retention. Evaluated data was from an ongoing prospective cohort study of adults aged 18 or older with DSM-5 moderate to severe OUD seeking MOUD in the community and followed for 6 months. Participants were considered retained on MOUD through 6 months if they reported taking MOUD at every study interview without discontinuation. A high dose of MOUD was defined as a methadone dose > 85 mg or buprenorphine dose ≥ 16 mg. Multivariable logistic regression was conducted to assess factors associated with 6-month MOUD retention. A total of 118 participants (73% male, 58% white, 36% with HIV) were included. Buprenorphine was initiated by 58% and 42% started methadone. MOUD retention was 49% and 58% among buprenorphine and methadone, respectively, at 6-months. In adjusted models, a high MOUD dose (OR = 4.71, 95% CI 2.05–10.84) and higher pain interference (OR = 1.59, 95% CI 1.15–2.19) was associated with MOUD retention. Adequate dosing of MOUD leads to improved retention on MOUD. Further, persons with high pain interference at baseline had higher odds of retention on MOUD. Both methadone and buprenorphine have analgesic effects, thus those with high pain interference could have dual benefits of MOUD for treating OUD and pain. Interventions should be tailored to improve adequate MOUD dosing to improve retention on MOUD.
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