Blum Kenneth, Han David, Modestino Edward J, Saunders Scott, Roy A Kennison, Jacobs W, Inaba Darryl S, Baron David, Oscar-Berman Marlene, Hauser Mary, Badgaiyan Rajendra D, Smith David E, Femino John, Gold Mark S
a Department of Psychiatry & McKnight Brain Institute , University of Florida College of Medicine , Gainesville , Florida , USA.
b Division of Addiction Services , Dominion Diagnostics, LLC , North Kingstown , Rhode Island , USA.
Subst Use Misuse. 2018 Jan 28;53(2):220-229. doi: 10.1080/10826084.2017.1400064. Epub 2017 Dec 19.
Buprenorphine and naloxone (bup/nal), a combination partial mu receptor agonist and low-dose delta mu antagonist, is presently recommended and used to treat opioid-use disorder. However, a literature review revealed a paucity of research involving data from urine drug tests that looked at compliance and abstinence in one sample.
Statistical analysis of data from the Comprehensive Analysis of Reported Drugs (CARD) was used to assess compliance and abstinence during treatment in a large cohort of bup/nal patients attending chemical-dependency programs from eastern USA in 2010 and 2011.
Part 1: Bup/nal was present in 93.4% of first (n = 1,282; p <.0001) and 92.4% of last (n = 1,268; p <.0001) urine samples. Concomitantly, unreported illicit drugs were present in 47.7% (n = 655, p =.0261) of samples. Patients who were compliant to the bup/nal prescription were more likely than noncompliant patients to be abstinent during treatment (p =.0012; odds ratio = 1.69 with 95% confidence interval (1.210, 2.354). Part 2: An analysis of all samples collected in 2011 revealed a significant improvement in both compliance (p < 2.2 × 10) and abstinence (p < 2.2 × 10) during treatment. Conclusion/Importance: While significant use of illicit opioids during treatment with bup/nal is present, improvements in abstinence and high compliance during maintenance-assisted therapy programs may ameliorate fears of diversion in comprehensive programs. Expanded clinical datasets, the treatment modality, location, and year of sampling are important covariates, for further studies. The potential for long-term antireward effects from bup/nal use requires consideration in future investigations.
丁丙诺啡和纳洛酮（丁丙/纳洛），一种部分μ受体激动剂与低剂量δμ拮抗剂的组合，目前被推荐并用于治疗阿片类药物使用障碍。然而，一项文献综述显示，涉及尿液药物检测数据且针对单一样本中的依从性和戒断情况的研究较少。
对来自美国东部2010年和2011年参加化学依赖项目的大量丁丙/纳洛患者队列治疗期间的数据进行统计分析，以评估依从性和戒断情况。
第一部分：丁丙/纳洛存在于93.4%的首次尿液样本（n = 1282；p <.0001）和92.4%的末次尿液样本（n = 1268；p <.0001）中。与此同时，47.7%（n = 655，p =.0261）的样本中存在未报告的非法药物。在治疗期间，依从丁丙/纳洛处方的患者比不依从的患者更有可能戒断（p =.0012；优势比 = 1.69，95%置信区间为(1.210, 2.354)）。第二部分：对2011年收集的所有样本进行分析发现，治疗期间依从性（p < 2.2×10）和戒断情况（p < 2.2×10）均有显著改善。结论/重要性：虽然在丁丙/纳洛治疗期间存在大量非法阿片类药物使用情况，但维持辅助治疗项目中戒断情况的改善和高依从性可能会减轻综合项目中对药物转移的担忧。扩展的临床数据集、治疗方式、地点和采样年份是进一步研究的重要协变量。丁丙/纳洛使用产生长期抗奖赏效应的可能性需要在未来研究中予以考虑。
