Mediating effect of craving on the impact of buprenorphine/naloxone and methadone treatment on opioid use: Results from a randomized controlled trial

被引：2

作者：

McAnulty, Christina ^{[1
,2
]}

Bastien, Gabriel ^{[1
,2
]}

Ledjiar, Omar ^{[3
]}

Socias, M. Eugenia ^{[4
,5
]}

Le Foll, Bernard ^{[6
,7
,8
,9
,10
,11
]}

Lim, Ron ^{[12
]}

Jutras-Aswad, Didier ^{[1
,2
,13
]}

机构：

[1] Univ Montreal, Fac Med, Dept Psychiat & Addictol, 2900 Boul Edouard Montpetit, Montreal, PQ H3T 1J4, Canada

[2] Ctr Hosp Univ Montreal CRCHUM, Res Ctr, 900 St Denis St, Montreal, PQ H2X 0A9, Canada

[3] Ctr Hosp St Justine, URCA, Res Ctr, 3175 Chemin Cote St Catherine, Montreal, PQ H3T 1C5, Canada

[4] British Columbia Ctr Subst Use, 400-1045 Howe St, Vancouver, BC V6Z 2A9, Canada

[5] Univ British Columbia, Dept Med, Fac Med, 1045 Howe St, Vancouver, BC V6Z 2A9, Canada

[6] Univ Toronto, Dept Family & Community Med, Fac Med, 500 Univ Ave,5th Floor, Toronto, ON M5G 1V7, Canada

[7] Univ Toronto, Dept Psychiat, 250 Coll St,8th Floor, Toronto, ON M5T 1R8, Canada

[8] Univ Toronto, Dalla Lana Sch Publ Hlth, 155 Coll St, Toronto, ON M5T 3M7, Canada

[9] Ctr Addict & Mental Hlth CAMH, Campbell Family Mental Hlth Res Inst, Translat Addict Res Lab, 33 Ursula Franklin St, Toronto, ON M5S 2S1, Canada

[10] Univ Toronto, Fac Med, Dept Pharmacol & Toxicol, Med Sci Bldg,1 Kings Coll Circle, Toronto, ON M5S 1A8, Canada

[11] Waypoint Res Inst, Waypoint Ctr Mental Hlth Care, 500 Church St, Penetanguishene, ON L9M 1G3, Canada

[12] Univ Calgary, Cumming Sch Med, Dept Psychiat & Family Med, 2500 Univ Dr NW, Calgary, AB T2N 1N4, Canada

[13] Ctr Hosp Univ Montreal, Res Ctr, 900 St Denis St,5th Floor,Room R05-746, Montreal, PQ H2X 0A9, Canada

来源：

ADDICTIVE BEHAVIORS | 2024年 / 154卷

基金：

加拿大健康研究院;

关键词：

Opioid; Craving; Addiction; Methadone; Buprenorphine; Dependence; USE DISORDER;

D O I：

10.1016/j.addbeh.2024.108023

中图分类号：

B849 [应用心理学];

学科分类号：

040203 ;

摘要：

Background: The relationship between opioid craving and opioid use is unclear. We sought to determine to what extent craving mediated the relationship between opioid agonist therapy and changes in opioid use. Methods: Data came from a pragmatic, 24-week, pan-Canadian, multi-centric, open-label, randomized controlled trial comparing flexible buprenorphine/naloxone take-home doses to standard supervised methadone models of care for the treatment of prescription-type opioid use disorder. Participants were randomly allocated to buprenorphine/naloxone or methadone models of care. 270 people with prescription-type opioid use disorder were included in analyses. There were 93 women (34.4%) and 2 transgender (0.7%) participants. Most participants were white (67.4%), 45.9% reported unstable living conditions, and 44.8% had psychiatric comorbidities. Generalized linear mixed models followed by mediation analysis estimated the direct effect of treatment group on Timeline Followback-reported next-week opioid use and the indirect effect through past 24-hour opioid craving measured using the Brief Substance Craving Scale at week 2, 6, 10, 14, 18 and 22. Results: Upon mediation analysis, the average direct effect of treatment on opioid use was 0.465 (95 % CI = 0.183 to 0.751, p < 0.001). The average causal mediated effect was 0.144 (95 % CI = 0.021 to 0.110; p < 0.001). Craving accounted for 23.6 % of the effect of treatment on opioid use (p < 0.001). Conclusions: Past 24-hour craving was associated with increased next-week opioid use; however, craving only partially mediated the effect of buprenorphine/naloxone and methadone on next-week opioid use. Research is needed to develop a comprehensive understanding of factors mediating opioid use during opioid agonist therapy.

引用

页数：7