Mogali Shanthi, Khan Nabil A, Drill Esther S, Pavlicova Martina, Sullivan Maria A, Nunes Edward, Bisaga Adam
Division of Substance Abuse, New York State Psychiatric Institute, New York, NY.
Department of Biostatistics, Columbia University, New York, NY.
Am J Addict. 2015 Apr;24(3):258-264. doi: 10.1111/ajad.12180.
Extended-release (XR) injection naltrexone has proved promising in the treatment of opioid dependence. Induction onto naltrexone is often accomplished with a procedure known as rapid naltrexone induction. The purpose of this study was to evaluate pre-treatment patient characteristics as predictors of successful completion of a rapid naltrexone induction procedure prior to XR naltrexone treatment.
A chart review of 150 consecutive research participants (N = 84 completers and N = 66 non-completers) undergoing a rapid naltrexone induction with the buprenorphone-clonidine procedure were compared on a number of baseline demographic, clinical and psychosocial factors. Logistic regression was used to identify client characteristics that may predict successful initiation of naltrexone after a rapid induction-detoxification.
Patients who failed to successfully initiate naltrexone were younger (AOR: 1.040, CI: 1.006, 1.075), and using 10 or more bags of heroin (or equivalent) per day (AOR: 0.881, CI: 0.820, 0.946). Drug use other than opioids was also predictive of failure to initiate naltrexone in simple bivariate analyses, but was no longer significant when controlling for age and opioid use level.
Younger age, and indicators of greater substance dependence severity (more current opioid use, other substance use) predict difficulty completing a rapid naltrexone induction procedure. Such patients might require a longer period of stabilization and/or more gradual detoxification prior to initiating naltrexone.
Our study findings identify specific characteristics of patients who responded positively to rapid naltrexone induction.
缓释注射用纳曲酮已被证明在治疗阿片类药物依赖方面很有前景。纳曲酮的诱导治疗通常通过一种称为快速纳曲酮诱导的程序来完成。本研究的目的是评估治疗前患者的特征，作为在接受缓释纳曲酮治疗之前快速纳曲酮诱导程序成功完成的预测指标。
对150名连续的研究参与者（84名完成者和66名未完成者）进行图表回顾，这些参与者采用丁丙诺啡-可乐定程序进行快速纳曲酮诱导，并比较了一些基线人口统计学、临床和心理社会因素。使用逻辑回归来确定可能预测快速诱导脱毒后纳曲酮成功启动的患者特征。
未能成功启动纳曲酮的患者年龄较小（调整后比值比[AOR]：1.040，置信区间[CI]：1.006，1.075），且每天使用10袋或更多海洛因（或等效物）（AOR：0.881，CI：0.820，0.946）。在简单的双变量分析中，除阿片类药物外的其他药物使用也可预测纳曲酮启动失败，但在控制年龄和阿片类药物使用水平后不再显著。
年龄较小以及物质依赖严重程度较高（当前阿片类药物使用更多、其他物质使用）的指标预示着快速纳曲酮诱导程序难以完成。这类患者在启动纳曲酮之前可能需要更长时间的稳定期和/或更缓慢的脱毒过程。
我们的研究结果确定了对快速纳曲酮诱导有积极反应患者的具体特征。
