A Systematic, Intensive Statistical Investigation of Data from the Comprehensive Analysis of Reported Drugs (CARD) for Compliance and Illicit Opioid Abstinence in Substance Addiction Treatment with Buprenorphine/naloxone
A Systematic, Intensive Statistical Investigation of Data from the Comprehensive Analysis of Reported Drugs (CARD) for Compliance and Illicit Opioid Abstinence in Substance Addiction Treatment with Buprenorphine/naloxone
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DOI：
10.1080/10826084.2017.1400064
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发表时间：
2018-01-01
影响因子：
2
通讯作者：
Gold, Mark S.
中科院分区：
文献类型：
--
作者：
Blum, Kenneth;Han, David;Gold, Mark S.
背景：丁丙诺啡和纳洛酮(BUP/NAL)是一种部分Mu受体激动剂和小剂量Delta Mu拮抗剂的组合，目前被推荐用于阿片类药物使用障碍的治疗。然而，一项文献综述显示，涉及尿液药物测试数据的研究很少，这些数据着眼于一个样本的依从性和禁欲。方法：对报告药物综合分析(CARD)的数据进行统计分析，以评估2010年和2011年在美国东部参加化学依赖计划的大量BUP/NAL患者治疗期间的依从性和禁欲。结果：第一部分：93.4%的第一次(n=1,282；p<；.0001)和92.4%的最后(n=1,268；p<；.0001)尿样中存在BUP/NAL。与此同时，47.7%的样本中存在未报告的非法药物(n=655，p=0.0261)。在治疗期间，遵守BUP/NAL处方的患者比不遵守处方的患者更有可能戒烟(p=0.0012；优势比=1.69，95%可信区间为1.210，2.354)。第二部分：对2011年收集的所有样本的分析显示，在治疗期间，依从性(P<；2.2 x 10(-16))和禁欲(P<；2.2 x 10(-16))均有显著改善。结论/重要性：虽然在BUP/NAL治疗期间大量使用非法阿片类药物，但在维持辅助治疗计划期间在戒断和高依从性方面的改善可能会减轻对综合计划中转移的担忧。扩展的临床数据集、治疗方式、地点和采样年份是进一步研究的重要协变量。在未来的调查中需要考虑使用BUP/NAL可能产生的长期反奖赏效应。
Background: Buprenorphine and naloxone (bup/nal), a combination partial mu receptor agonist and low-dose delta mu antagonist, is presently recommended and used to treat opioid-use disorder. However, a literature review revealed a paucity of research involving data from urine drug tests that looked at compliance and abstinence in one sample. Method: Statistical analysis of data from the Comprehensive Analysis of Reported Drugs (CARD) was used to assess compliance and abstinence during treatment in a large cohort of bup/nal patients attending chemical-dependency programs from eastern USA in 2010 and 2011. Results: Part 1: Bup/nal was present in 93.4% of first (n = 1,282; p < .0001) and 92.4% of last (n = 1,268; p < .0001) urine samples. Concomitantly, unreported illicit drugs were present in 47.7% (n = 655, p = .0261) of samples. Patients who were compliant to the bup/nal prescription were more likely than noncompliant patients to be abstinent during treatment (p = .0012; odds ratio = 1.69 with 95% confidence interval (1.210, 2.354). Part 2: An analysis of all samples collected in 2011 revealed a significant improvement in both compliance (p < 2.2 x 10(-16)) and abstinence (p < 2.2 x 10(-16)) during treatment. Conclusion/Importance: While significant use of illicit opioids during treatment with bup/nal is present, improvements in abstinence and high compliance during maintenance-assisted therapy programs may ameliorate fears of diversion in comprehensive programs. Expanded clinical datasets, the treatment modality, location, and year of sampling are important covariates, for further studies. The potential for long-term antireward effects from bup/nal use requires consideration in future investigations.