阿片类使用障碍（OUD）经每月长效丁丙诺啡治疗后的康复：一项观察性研究 RECOVER 的 12 个月纵向结果。
Recovery From Opioid Use Disorder (OUD) After Monthly Long-acting Buprenorphine Treatment: 12-Month Longitudinal Outcomes From RECOVER, an Observational Study.
机构信息
UCLA Department of Family Medicine, Center for Behavioral & Addiction Medicine, Los Angeles, CA (WL); Indivior Inc, Richmond, VA (VRN, HC, SML, CH); RTI International, Research Triangle Park, NC (APA, NAR, VA); Pharmerit International, Bethesda, MD (CTS, CJ); John Hopkins Bloomberg School of Public Health, Baltimore, MD (HC); CamBright Research LLC, Durham, NC (VA); Artemis Institute for Clinical Research, San Diego, CA (VM).
出版信息
J Addict Med. 2020 Sep/Oct;14(5):e233-e240. doi: 10.1097/ADM.0000000000000647.
OBJECTIVES
While evidence has mounted regarding the short-term effectiveness of pharmacotherapy for opioid use disorder (OUD), little is known about longer-term psychosocial, economic, and health outcomes. We report herein 12-month outcomes for an observational study enrolling participants who had previously taken part in a long-acting buprenorphine subcutaneous injection (BUP-XR) trial for moderate to severe OUD.
METHODS
The RECOVER (Remission from Chronic Opioid Use: Studying Environmental and SocioEconomic Factors on Recovery; NCT03604861) study enrolled participants from 35 US community-based sites. Self-reported sustained opioid abstinence over 12 months and self-reported past-week abstinence at 3-, 6-, 9-, and 12-month visits were assessed. Multiple regression models assessed the association of BUP-XR duration with abstinence, controlling for potential confounders. Withdrawal, pain, health-related quality of life, depression, and employment at RECOVER baseline and 12-month visits were also compared to values collected before treatment in the BUP-XR trial.
RESULTS
Of 533 RECOVER participants, 425 completed the 12-month visit (average age 42 years; 66% male); 50.8% self-reported sustained 12-month and 68.0% past-week opioid abstinence. In multiple regressions, participants receiving 12-month versus ≤2-month BUP-XR treatment duration had significantly higher likelihood of sustained opioid abstinence (75.3% vs 24.1%; P = 0.001), with similar results for past-week self-reported abstinence over time. During RECOVER, participants had fewer withdrawal symptoms, lower pain, positive health-related quality of life, minimal depression, and higher employment versus pre-trial visit.
CONCLUSIONS
RECOVER participants reported positive outcomes over the 12-month observational period, including high opioid abstinence and stable or improved humanistic outcomes. These findings provide insights into the long-term impact of pharmacotherapy in OUD recovery.
目的
尽管已有大量证据表明药物治疗对阿片类药物使用障碍（OUD）的短期疗效，但对于较长时间的心理社会、经济和健康结果知之甚少。我们在此报告一项观察性研究的 12 个月结果，该研究纳入了先前参加过长效丁丙诺啡皮下注射（BUP-XR）治疗中重度 OUD 试验的参与者。
方法
RECOVER（从慢性阿片类药物使用中康复：研究环境和社会经济因素对康复的影响；NCT03604861）研究招募了来自美国 35 个社区基地的参与者。通过自我报告评估 12 个月内持续的阿片类药物戒断情况，以及在第 3、6、9 和 12 个月就诊时的过去一周的戒断情况。采用多元回归模型，控制潜在混杂因素，评估 BUP-XR 持续时间与戒断的相关性。还比较了 RECOVER 基线和 12 个月就诊时的戒断、疼痛、健康相关生活质量、抑郁和就业情况与 BUP-XR 试验治疗前的情况。
结果
在 533 名 RECOVER 参与者中，有 425 名完成了 12 个月的就诊（平均年龄 42 岁；66%为男性）；50.8%自我报告持续 12 个月和 68.0%过去一周阿片类药物戒断。在多元回归中，接受 12 个月与≤2 个月 BUP-XR 治疗时长的参与者有更高的持续阿片类药物戒断可能性（75.3% vs 24.1%；P = 0.001），且随时间推移，过去一周的自我报告戒断情况也相似。在 RECOVER 期间，参与者的戒断症状更少、疼痛更低、健康相关生活质量更高、抑郁程度更低、就业率更高，与试验前就诊相比。
结论
RECOVER 参与者报告了 12 个月观察期内的积极结果，包括高阿片类药物戒断率和稳定或改善的人文结局。这些发现提供了关于药物治疗对 OUD 康复长期影响的见解。
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