COMBINE 研究中阿片类药物滥用对酒精治疗结局的预测作用：药物依从性的中介作用。

Opioid Misuse as a Predictor of Alcohol Treatment Outcomes in the COMBINE Study: Mediation by Medication Adherence.

机构信息

Department of Psychology, University of New Mexico, Albuquerque, New Mexico.

Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico.

出版信息

Alcohol Clin Exp Res. 2018 Jul;42(7):1249-1259. doi: 10.1111/acer.13772. Epub 2018 Jun 9.

DOI:10.1111/acer.13772

PMID:29873089

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6063524/

Abstract

BACKGROUND

Alcohol is often consumed with opioids and alcohol misuse interferes with treatment for opioid use disorder (OUD). Drug misuse is associated with worse alcohol use disorder (AUD) treatment outcomes, yet no studies have investigated the role of opioid misuse in AUD treatment outcomes.

METHODS

We conducted secondary analyses of the medication conditions of the COMBINE study (n = 1,226), a randomized clinical trial of medications (acamprosate and/or naltrexone) and behavioral interventions (medication management and/or behavioral intervention) for alcohol dependence. We examined associations between baseline opioid misuse and the use of cannabis and other drugs with time to first drinking day, time to first heavy drinking day, and the frequency and intensity of drinking during treatment and 1 year following treatment, based on latent profile analysis. Opioid misuse was defined as use of illicit or prescription opioids without a prescription or not as directed in the previous 6 months, in the absence of OUD. Self-reported cannabis and other drug use were also examined. Seventy individuals (5.7%) met the opioid misuse definition and 542 (44.2%) reported use of cannabis or other drugs without opioid misuse. We also examined medication adherence as a potential mediator.

RESULTS

Baseline opioid misuse significantly predicted the time to first heavy drinking day (OR = 1.38 [95% CI: 1.13, 1.64], p = 0.001) and a higher probability of being in a heavier and more frequent drinking profile at the end of treatment (OR = 2.90 [95% CI: 1.43, 5.90], p = 0.003), and at 1 year following treatment (OR = 2.66 [95% CI: 1.26, 5.59], p = 0.01). Cannabis and other drug use also predicted outcomes. Medication adherence partially mediated the association between opioid misuse, cannabis use, other drug use, and treatment outcomes.

CONCLUSIONS

Opioid misuse and other drug use were associated with poorer AUD treatment outcomes, which was partially mediated by medication adherence. Clinicians and researchers should assess opioid misuse and other drug use in patients undergoing AUD treatment.

摘要

背景

酒精常与阿片类药物一同摄入，而酒精滥用会干扰阿片类药物使用障碍（OUD）的治疗。药物滥用与更差的酒精使用障碍（AUD）治疗结果相关，但尚无研究调查阿片类药物滥用在 AUD 治疗结果中的作用。

方法

我们对 COMBINE 研究（n=1226）的药物条件进行了二次分析，这是一项针对酒精依赖症的药物（安非他酮和/或纳曲酮）和行为干预（药物管理和/或行为干预）的随机临床试验。我们根据潜在剖面分析，检查了基线阿片类药物滥用与使用大麻和其他药物与首次饮酒日、首次重度饮酒日、治疗期间和治疗后 1 年的饮酒频率和强度之间的关联。阿片类药物滥用的定义为在过去 6 个月内未经处方或未按指示使用非法或处方阿片类药物，而无 OUD。还检查了自我报告的大麻和其他药物使用情况。70 人（5.7%）符合阿片类药物滥用的定义，542 人（44.2%）报告在没有阿片类药物滥用的情况下使用大麻或其他药物。我们还检查了药物依从性作为潜在的中介。

结果

基线阿片类药物滥用显著预测首次重度饮酒日的时间（OR=1.38[95%CI：1.13，1.64]，p=0.001）和治疗结束时更频繁、更频繁饮酒的可能性更高（OR=2.90[95%CI：1.43，5.90]，p=0.003），以及治疗后 1 年（OR=2.66[95%CI：1.26，5.59]，p=0.01）。大麻和其他药物的使用也预测了结果。药物依从性部分中介了阿片类药物滥用、大麻使用、其他药物使用与治疗结果之间的关联。