Impact of fentanyl use on initiation and discontinuation of methadone and buprenorphine/naloxone among people with prescription-type opioid use disorder: secondary analysis of a Canadian treatment trial

被引:20
作者
Socias, M. Eugenia [1 ,2 ]
Wood, Evan [1 ,2 ]
Le Foll, Bernard [3 ,4 ,5 ,6 ,7 ,8 ]
Lim, Ron [9 ]
Choi, Jin Cheol [1 ]
Mok, Wing Yin [1 ]
Bruneau, Julie [10 ,11 ]
Rehm, Juergen [5 ,6 ,12 ,13 ,14 ,15 ,16 ]
Wild, T. Cameron [17 ]
Bozinoff, Nikki [4 ,7 ]
Hassan, Ahmed [3 ,5 ,7 ]
Jutras-Aswad, Didier [10 ,18 ]
机构
[1] British Columbia Ctr Subst Use, Vancouver, BC, Canada
[2] Univ British Columbia, Dept Med, Fac Med, Vancouver, BC, Canada
[3] Univ Toronto, Fac Med, Dept Pharmacol & Toxicol, Med Sci Bldg, Toronto, ON, Canada
[4] Univ Toronto, Dept Family & Community Med, Fac Med, Toronto, ON, Canada
[5] Univ Toronto, Dept Psychiat, Toronto, ON, Canada
[6] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
[7] Ctr Addict & Mental Hlth CAMH, Campbell Family Mental Hlth Res Inst, Toronto, ON, Canada
[8] CAMH, Acute Care Programme, Toronto, ON, Canada
[9] Univ Calgary, Cumming Sch Med, Dept Family Med & Psychiat, Calgary, AB, Canada
[10] Ctr Hosp Univ Montreal CRCHUM, Res Ctr, Montreal, PQ, Canada
[11] Univ Montreal, Dept Family & Emergency Med, Fac Med, Montreal, PQ, Canada
[12] CAMH, Inst Mental Hlth Policy Res, Toronto, ON, Canada
[13] Tech Univ Dresden, Inst Clin Psychol, Dresden, Germany
[14] Tech Univ Dresden, Psychotherapy Ctr, Dresden, Germany
[15] Tech Univ Dresden, Ctr Clin Epidemiol & Longitudinal Studies, Dresden, Germany
[16] IM Sechenov First Moscow State Med Univ, Inst Leadership & Hlth Management, Dept Int Hlth Projects, Moscow, Russia
[17] Univ Alberta, Sch Publ Hlth, Edmonton, AB, Canada
[18] Univ Montreal, Dept Psychiat & Addictol, Fac Med, Montreal, PQ, Canada
基金
加拿大健康研究院;
关键词
Buprenorphine; clinical trial; fentanyl; methadone; opioid use disorder; prescription opioids; UNITED-STATES; DEPENDENCE; RETENTION;
D O I
10.1111/add.15954
中图分类号
R194 [卫生标准、卫生检查、医药管理];
学科分类号
摘要
Background and aims Fentanyl is primarily responsible for the current phase of the overdose epidemic in North America. Despite the benefits of treatment with medications for opioid use disorder (MOUD), there are limited data on the association between fentanyl, MOUD type and treatment engagement. The objectives of this analysis were to measure the impact of baseline fentanyl exposure on initiation and discontinuation of MOUD among individuals with prescription-type opioid use disorder (POUD). Design, setting and participants Secondary analysis of a Canadian multi-site randomized pragmatic trial conducted between 2017 and 2020. Of the 269 randomized participants, 65.4% were male, 67.3% self-identified as white and 55.4% had a positive fentanyl urine drug test (UDT) at baseline. Fentanyl-exposed participants were more likely to be younger, to self-identify as non-white, to be unemployed or homeless and to be currently using stimulants than non-fentanyl-exposed participants. Interventions Flexible take-home dosing buprenorphine/naloxone or supervised methadone models of care for 24 weeks. Measurements Outcomes were (1) MOUD initiation and (2) time to (a) assigned and (b) overall MOUD discontinuation. Independent variables were baseline fentanyl UDT (predictor) and assigned MOUD (effect modifier). Findings Overall, 209 participants (77.7%) initiated MOUD. In unadjusted analyses, fentanyl exposure was associated with reduced likelihood of treatment initiation [odds ratio (OR) = 0.18, 95% confidence interval (CI) = 0.08-0.36] and shorter median times in assigned [20 versus 168 days, hazard ratio (HR) = 3.61, 95% CI = 2.52-5.17] and any MOUD (27 versus 168 days, HR = 3.32, 95% CI = 2.30-4.80). The negative effects were no longer statistically significant in adjusted models, and no interaction between fentanyl and MOUD was observed for any of the outcomes (all P > 0.05). Conclusions Both buprenorphine/naloxone and methadone may be appropriate treatment options for people with prescription-type opioid use disorder regardless of fentanyl exposure. Other characteristics of fentanyl-exposed individuals appear to be driving the association with poorer treatment outcomes.
引用
收藏
页码:2662 / 2672
页数:11
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