Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA; School of Medicine, Universidad Xochicalco, Tijuana, Mexico.
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
Drug Alcohol Depend. 2019 Apr 1;197:354-360. doi: 10.1016/j.drugalcdep.2018.12.018. Epub 2019 Jan 22.
Opioid agonist treatment (OAT) is an effective biomedical intervention to manage opioid use disorder among persons who inject drugs (PWID). Preliminary evidence suggests that OAT may also disrupt the social communicability of injection drug use (IDU) practices by established PWID. We therefore aim to investigate the association between OAT enrollment and initiating others into IDU among PWID in Vancouver, Canada.
Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256-01) is a prospective multi-cohort study seeking to identify structural interventions that reduce the risk that PWID initiate others into IDU. The present analysis was conducted using data from a participating cohort of PWID in Vancouver, Canada, between December 2014 and May 2017. Multivariable logistic regression models were built to assess the association between reporting active (i.e., within the past six months) OAT enrollment and assisting others in injection initiation. A final model was determined using a manual stepwise approach whereby covariates were excluded if their removal altered the coefficient of interest by <5%.
Participants (n = 1740) were predominantly male (62.3%); 35.1% reported daily injecting (n = 611); 860 (49.4%) reported active OAT enrollment, and 80 (4.6%) reported recently providing injection initiation assistance. In a multivariable model, participants who reported active OAT enrollment had significantly lower odds of recently providing injection initiation assistance (Adjusted Odds Ratio = 0.52, 95% Confidence Interval: 0.31-0.87, P = 0.01).
Results suggest a protective association between OAT and the expansion of IDU practices among vulnerable populations, suggesting its potential use as 'addiction treatment as prevention.'
阿片类激动剂治疗（OAT）是一种有效的生物医学干预措施，可用于管理注射吸毒者（PWID）的阿片类药物使用障碍。初步证据表明，OAT 也可能通过已建立的 PWID 破坏注射吸毒行为（IDU）的社会传播性。因此，我们旨在调查加拿大温哥华的 PWID 中 OAT 入组与他人开始 IDU 之间的关联。
通过修改现有反应来预防注射（PRIMER；NIDA DP2-DA040256-01）是一项前瞻性多队列研究，旨在确定降低 PWID 使他人开始 IDU 风险的结构干预措施。本分析使用加拿大温哥华参与队列的 PWID 数据进行，时间为 2014 年 12 月至 2017 年 5 月。使用多变量逻辑回归模型评估报告正在进行的（即过去六个月内）OAT 入组和协助他人注射开始之间的关联。使用手动逐步方法确定最终模型，即如果去除协变量会使感兴趣的系数改变 <5%，则会将其排除在外。
参与者（n=1740）主要为男性（62.3%）；35.1%报告每天注射（n=611）；860（49.4%）报告正在进行的 OAT 入组，80（4.6%）报告最近提供注射开始协助。在多变量模型中，报告正在进行的 OAT 入组的参与者最近提供注射开始协助的可能性显著降低（调整后的优势比=0.52，95%置信区间：0.31-0.87，P=0.01）。
结果表明，OAT 与脆弱人群中 IDU 行为的扩展之间存在保护关联，表明其可能作为“治疗即预防”被用于成瘾治疗。
