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美沙酮-纳洛酮治疗对有海洛因和处方类阿片使用障碍的年轻成年人的反应不同。

Buprenorphine-naloxone treatment responses differ between young adults with heroin and prescription opioid use disorders.

机构信息

Division of Addiction Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.

MAYU of New England, New Haven, Connecticut.

出版信息

Am J Addict. 2017 Dec;26(8):838-844. doi: 10.1111/ajad.12641. Epub 2017 Nov 16.

DOI:10.1111/ajad.12641
PMID:29143399
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5772882/
Abstract

BACKGROUND AND OBJECTIVES

Opioid use disorder among young adults is rising sharply with an increase in morbidity and mortality. This study examined differences in treatment response to a fixed dose of buprenorphine-naloxone between heroin (HU) and prescriptions opioids (POU) users.

METHODS

Eighty opioid dependent young adults (M = 22 years) were treated with buprenorphine-naloxone 16-4 mg/day for 8 weeks. Differences between HU (N = 17) and POU (N = 63) on changes in weekly opioid use, opioid craving, withdrawal, and depression symptoms were analyzed with mixed-effects regression models.

RESULTS

The HU had an overall mean proportion of weekly opioid use of .32 (SD = .14) compared to POU's weekly mean of .24 (SD = .15) showing a significant main effect (Z = 2.21, p = .02). Depressive symptoms (CES-D scores) were elevated at baseline for both groups (HU: M = 23.1, SD = 11.9; PO: M = 22.2, SD = 9.4), but only POU improved significantly to a score of 9.88 (SD = 7.4) compared to HU's score of 18.58 (SD = 10.3) at week 8 (Z = 2.24, p = .02). There were no significant differences in treatment retention, craving, or withdrawal symptoms.

DISCUSSION AND CONCLUSIONS

Treatment response to 16-4 mg/day of buprenorphine-naloxone was significantly diminished for heroin users relative to opioid prescription users in weekly opioid use. Heroin users also had persistent depressive symptoms suggesting the need for close monitoring.

SCIENTIFIC SIGNIFICANCE

These data suggest that young heroin users might require higher doses of buprenorphine. (Am J Addict 2017;26:838-844).

摘要

背景与目的

年轻人中阿片类药物使用障碍的发病率和死亡率急剧上升。本研究旨在探讨海洛因（HU）和处方类阿片药物（POU）使用者对固定剂量丁丙诺啡-纳洛酮治疗反应的差异。

方法

80 名阿片类药物依赖的年轻成年人（M=22 岁）接受丁丙诺啡-纳洛酮 16-4mg/天治疗 8 周。采用混合效应回归模型分析 HU（N=17）和 POU（N=63）在每周阿片类药物使用量、阿片类药物渴求、戒断和抑郁症状变化方面的差异。

结果

HU 每周阿片类药物使用的平均比例为 0.32（SD=0.14），而 POU 的每周平均比例为 0.24（SD=0.15），差异有统计学意义（Z=2.21，p=0.02）。两组的抑郁症状（CES-D 评分）均在基线时升高（HU：M=23.1，SD=11.9；PO：M=22.2，SD=9.4），但只有 POU 在第 8 周时显著改善至 9.88（SD=7.4），而 HU 则为 18.58（SD=10.3）（Z=2.24，p=0.02）。两组在治疗保留率、渴求或戒断症状方面无显著差异。

讨论与结论

与处方类阿片药物使用者相比，16-4mg/天丁丙诺啡-纳洛酮治疗 HU 使用者的每周阿片类药物使用量明显减少。HU 使用者还存在持续性抑郁症状，表明需要密切监测。

科学意义

这些数据表明，年轻的海洛因使用者可能需要更高剂量的丁丙诺啡。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2fe8/5772882/3e0a4226c59e/nihms922677f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2fe8/5772882/66ff863f268a/nihms922677f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2fe8/5772882/3e0a4226c59e/nihms922677f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2fe8/5772882/66ff863f268a/nihms922677f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2fe8/5772882/3e0a4226c59e/nihms922677f2.jpg

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