Trajectories of craving during medication-assisted treatment for opioid-use disorder: Subtyping for early identification of higher risk.
Trajectories of craving during medication-assisted treatment for opioid-use disorder: Subtyping for early identification of higher risk.
复制标题
DOI：
10.1016/j.drugalcdep.2022.109362
复制
发表时间：
2022-04-01
影响因子：
4.2
通讯作者：
Epstein DH
中科院分区：
文献类型：
--
作者：
Burgess-Hull AJ;Panlilio LV;Preston KL;Epstein DH
检查阿片类药物使用障碍（MOUD）治疗期间阿片类药物渴求轨迹亚型的证据，并（a）检测这些亚型在MOUD相关结局方面是否存在差异，（B）确定治疗开始前是否可以识别无应答者。门诊患者（n = 211）接受丁丙诺啡或美沙酮治疗长达16周。生长混合模型用于识别未观察到的渴望轨迹亚型。支持向量机（SVM）进行训练，以预测亚型成员从预处理数据。自我报告的阿片类药物渴望（生态瞬时评估- EMA -每天三个随机时刻）。药物使用或高于平时的压力的患者启动的EMA报告。成瘾严重程度指数（ASI）预处理。确定了四种渴望轨迹：低（73%）;高和增加（HIC）（10.9%）;增加和减少（8.5%）;和快速下降（7.6%）。HIC亚组报告在治疗期间海洛因、任何阿片类药物和大麻的使用率最高。低渴望亚组报告海洛因或任何阿片类药物的使用最低，治疗期间的压力和药物线索暴露水平最低。在治疗开始前预测HIC成员资格的SVM模型的灵敏度为0.70，特异性为0.78，准确性为0.77。包括3周EMA报告的敏感性增加至0.78，特异性增加至0.84，准确性增加至0.85。MOUD患者的亚组在治疗期间显示出不同的阿片类药物渴求模式。亚组在关键结果上存在差异，包括药物使用失误，压力和暴露于药物线索。来自入组和早期治疗的数据可能有助于集中临床注意力。
To examine evidence for subtypes of opioid craving trajectories during medication for opioid use disorder (MOUD), and to (a) test whether these subtypes differed on MOUD-related outcomes, and (b) determine whether nonresponders could be identified before treatment initiation. Outpatients (n = 211) being treated with buprenorphine or methadone for up to 16 weeks. Growth mixture modeling was used to identify unobserved craving-trajectory subtypes. Support Vector Machines (SVM) were trained to predict subtype membership from pretreatment data. Self-reported opioid craving (Ecological Momentary Assessment – EMA – three random moments per day). Participant-initiated EMA reports of drug use or higher-than-usual stress. Addiction Severity Index (ASI) pretreatment. Four craving trajectories were identified: Low (73%); High and Increasing (HIC) (10.9%); Increasing and Decreasing (8.5%); and Rapidly Declining (7.6%). The HIC subgroup reported the highest use of heroin, any opiate, and cannabis during treatment. The Low Craving subgroup reported the lowest use of heroin or any opiate use, and the lowest levels of stress and drug-cue exposure during treatment. SVM models predicting HIC membership before treatment initiation had a sensitivity of 0.70, specificity of 0.78, and accuracy of 0.77. Including 3 weeks of EMA reports increased sensitivity to 0.78, specificity to 0.84, and accuracy to 0.85. Subgroups of MOUD patients show distinct patterns of opioid craving during treatment. Subgroups differ on critical outcomes including drug-use lapse, stress, and exposure to drug cues. Data from enrollment and early in treatment may help focus clinical attention.
登录
查看更多内容
影响因子：
3.4
作者：
Preston KL;Kowalczyk WJ;Phillips KA;Jobes ML;Vahabzadeh M;Lin JL;Mezghanni M;Epstein DH
通讯作者：
Epstein DH
影响因子：
3.4
作者：
JAFFE, JH;CASCELLA, NG;SHERER, MA
通讯作者：
SHERER, MA
影响因子：
1.9
作者：
MCLELLAN, AT;LUBORSKY, L;OBRIEN, CP
通讯作者：
OBRIEN, CP
影响因子：
6
作者：
Carter, BL;Tiffany, ST
通讯作者：
Tiffany, ST
影响因子：
5.8
作者：
Proust-Lima, Cecile;Philipps, Viviane;Liquet, Benoit
通讯作者：
Liquet, Benoit