A pilot randomized controlled trial of assertive treatment including family involvement and home delivery of medication for young adults with opioid use disorder
A pilot randomized controlled trial of assertive treatment including family involvement and home delivery of medication for young adults with opioid use disorder
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DOI：
10.1111/add.15181
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发表时间：
2020-08-04
期刊：
影响因子：
6
通讯作者：
Burgower, Rachael
中科院分区：
文献类型：
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作者：
Fishman, Marc;Wenzel, Kevin;Burgower, Rachael
背景和目标 虽然治疗阿片类药物使用障碍 (OUD) 的药物，包括缓释纳曲酮 (XR-NTX)，已被证明有效，但依从性往往较低。我们测试了青少年阿片类药物恢复支持 (YORS) 的初步疗效，这是一种多成分干预措施，旨在提高 OUD 患者的参与度和药物依从性。设计单中心随机对照试验，随访 24 周。在美国马里兰州巴尔的摩制定社区药物使用障碍治疗计划。参与者 18-26 岁的年轻人参加了住院/住院 OUD 治疗，打算使用 XR-NTX 进行门诊 OUD 治疗。 21 名参与者被随机分配至 YORS，20 名参与者被随机分配至照常治疗 (TAU)。分析样本中 65.8% 为男性。 YORS 的干预和比较组件包括： (1) XR-NTX 送货上门； (2) 家庭参与； (3) 积极主动的外展活动； (4) 接受 XR-NTX 剂量的应急管理。比较对象是 TAU，包括住院后转诊至门诊护理的标准情况。测量 主要结果是 24 周内接受的 XR-NTX 剂量数量以及 24 周时复发阿片类药物使用（定义为 28 天内使用 >= 10 天）。结果 YORS 状况的参与者接受了更多的 XR-NTX 剂量 [平均值 = 4.28；标准差 (SD) = 2.3] 与 TAU 相比（平均值 = 0.70；SD = 1.2），P < 0.01。与 TAU 组相比，YORS 组的参与者复发率较低（61% vs 95%；P < 0.01）。生存分析显示，复发时间存在组间差异，与 YORS 患者相比，TAU 患者更有可能更快复发 [风险比 (HR) = 2.72，95% 置信区间 (CI) = 1.26-5.88，P < 0.01]。结论 与标准治疗相比，针对阿片类药物使用障碍的年轻人的缓释纳曲酮依从性和预防阿片类药物复发的青少年阿片类药物康复支持干预似乎可以改善治疗和复发结果。
Background and Aims Although medications for opioid use disorder (OUD), including extended-release naltrexone (XR-NTX), have demonstrated effectiveness, adherence is often low. We tested the preliminary efficacy of youth opioid recovery support (YORS), a multi-component intervention designed to improve engagement and medication adherence for young adults with OUD. Design Single-site randomized controlled trial with 24-week follow-up. Setting Community substance use disorder treatment program in Baltimore, MD, USA. Participants Young adults aged 18-26 years enrolled in inpatient/residential OUD treatment intending to pursue outpatient OUD treatment with XR-NTX. Twenty-one participants were randomized to YORS and 20 to treatment as usual (TAU). The analyzed sample was 65.8% male. Intervention and comparator Components of YORS include: (1) home delivery of XR-NTX; (2) family engagement; (3) assertive outreach; and (4) contingency management for receipt of XR-NTX doses. The comparator was TAU, which consisted of a standard referral to outpatient care following an inpatient stay. Measurements Primary outcomes were number of XR-NTX doses received over 24 weeks and relapse to opioid use (defined as >= 10 days of use within 28 days) at 24 weeks. Findings Participants in the YORS condition received more XR-NTX doses [mean = 4.28; standard deviation (SD) = 2.3] compared with those in TAU (mean = 0.70; SD = 1.2),P < 0.01. Participants in the YORS group compared with TAU had lower rates of relapse (61 versus 95%;P < 0.01). Survival analyses revealed group differences on time to relapse with participants in TAU being more likely to relapse sooner compared with participants in the YORS condition [hazard ratio (HR) = 2.72, 95% confidence interval (CI) = 1.26-5.88,P < 0.01]. Conclusions The youth opioid recovery support intervention for extended-release naltrexone adherence and opioid relapse prevention among young adults with opioid use disorder appeared to improve treatment and relapse outcomes compared with standard treatment.