Naturalistic follow-up after a trial of medications for opioid use disorder: Medication status, opioid use, and relapse.
Naturalistic follow-up after a trial of medications for opioid use disorder: Medication status, opioid use, and relapse.
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DOI：
10.1016/j.jsat.2021.108447
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发表时间：
2021-12
影响因子：
3.9
通讯作者：
Nunes EV
中科院分区：
文献类型：
--
作者：
Greiner MG;Shulman M;Choo TH;Scodes J;Pavlicova M;Campbell ANC;Novo P;Fishman M;Lee JD;Rotrosen J;Nunes EV
本报告检查了国家药物滥用治疗临床试验网络（CTN）缓释纳洛酮（XR-NTX）与丁丙诺啡-纳洛酮（BUP-NX）阿片类药物治疗试验（CTN-0051，X：BOT）中随机化后36周的自然阿片类药物使用结局和阿片类药物使用障碍（MOUD）的药物利用。X：BOT是一项比较BUP-NX（N=287）和XR-NTX（N=283）的多中心、随机、24周有效性试验。在治疗完成、复发或脱落后停用研究药物。鼓励与会者继续MOUD。该报告检查了参加36周随访的570名参与者中的428名（75%）的阿片类药物使用结果。从美国8个社区治疗项目中招募的阿片类药物使用障碍成年人。结局包括用药状态（开/关MOUD）、MOUD类型（BUP-NX、XR-NTX或美沙酮）、非处方阿片类药物戒断、阿片类药物使用天数、复发和36周访视前30天使用其他物质。复发定义为过去一个月内连续4周或连续7天使用阿片类药物。基线和临床变量包括阿片类药物使用严重程度、静脉注射药物使用、研究药物分配和诱导状态。在完成36周访视的428名参与者中，225名（53%）参与者正在接受MOUD，203名（47%）未接受。与那些没有服药的人相比，服药的参与者使用阿片类药物的天数更少（4.4天（SD 9.0）vs 9.8天）（SD 12.1），符合复发标准的患者较少（37例（16.4%）vs 79例（38.9%）），报告兴奋剂使用较少（34例（15.2%）vs 56例（27.7%））和镇静剂使用较少（14例（6.3%）vs 31例（15.3%））。有或无MOUD之间的禁欲率没有差异。与丁丙诺啡（120名参与者中的28名（23.3%））相比，XR-NTX（88名参与者中的47名（53.4%））参与者中有更大比例的非处方阿片类药物。自然结果数据显示，尽管在社区中继续治疗存在潜在障碍，但约有一半的人在随访时接受阿片类药物使用障碍药物治疗，而那些接受药物治疗的人通常有更好的结果。未来的研究应探讨在社区环境中保留治疗的障碍和促进因素;并制定专门的干预措施，以提高治疗的参与和依从性。
This report examined naturalistic opioid use outcomes and utilization of medications for opioid use disorder (MOUD) 36 weeks post-randomization in the National Drug Abuse Treatment Clinical Trials Network (CTN) Extended-Release Naltrexone (XR-NTX) versus Buprenorphine-Naloxone (BUP-NX) for Opioid Treatment trial (CTN-0051, X:BOT). X:BOT was a multisite, randomized, 24-week comparative effectiveness trial of BUP-NX (N=287) and XR-NTX (N=283). Study medications were discontinued following treatment completion, relapse, or dropout. Participants were encouraged to continue MOUD. This report examined opioid use outcomes in 428 (75%) of the 570 participants who attended the 36-week follow-up visit. Adults with opioid use disorder recruited from 8 community treatment programs across the United States. Outcomes included medication status (on/off MOUD), type of MOUD (BUP-NX, XR-NTX, or methadone), abstinence from non-prescribed opioids, opioid use days, relapse, and other substance use 30 days prior to the 36-week visit. Relapse was defined as opioid use for 4 consecutive weeks or 7 consecutive days in the past month. Baseline and clinical variables included opioid use severity, intravenous drug use, study medication assignment, and induction status. Of the 428 participants who completed the 36-week visit, 225 (53%) of participants were receiving MOUD and 203 (47%) were not. Compared to those off medication, participants on medication had fewer opioid use days (4.4 days (SD 9.0) versus 9.8 days (SD 12.1), fewer met relapse criteria (37 (16.4%) versus 79 (38.9%)), and reported less stimulant use (34 (15.2%) versus 56 (27.7%)) and sedative use (14 (6.3%) versus 31 (15.3%)). There was no difference in abstinence rates between those on or off MOUD. A greater proportion of participants on XR-NTX (47 (53.4%) of 88 participants) were abstinent from non-prescribed opioids compared to those on buprenorphine (28 (23.3%) of 120 participants). Naturalistic outcomes data showed that despite potential barriers to continuing treatment in the community, about half of individuals were on opioid use disorder pharmacotherapy at follow-up and those on medication generally had better outcomes. Future research should explore barriers and facilitators to treatment retention in community settings; and developing interventions tailored to improve treatment engagement and adherence.
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