New York University Grossman School of Medicine, One Park Avenue, 8(th) Fl., New York, NY, 10016, United States of America.
New York University Grossman School of Medicine, One Park Avenue, 8(th) Fl., New York, NY, 10016, United States of America.
J Subst Abuse Treat. 2021 Mar;122:108183. doi: 10.1016/j.jsat.2020.108183. Epub 2020 Oct 22.
The National Drug Abuse Treatment Clinical Trials Network (CTN) multisite comparative-effectiveness study ("X:BOT") by Lee et al. (2018) found that, once initiated, extended-release naltrexone (XR-NTX) is as similarly safe and effective as sublingual buprenorphine-naloxone (BUP-NX) for the treatment of opioid use disorder (OUD). However, the detoxification hurdle makes XR-NTX much more difficult to initiate than BUP-NX. This hurdle highlights the need to better understand how patients transition from active opioid use to XR-NTX treatment.
To explore patient-identified barriers and facilitators to initiating antagonist treatment (XR-NTX) within the context of an inpatient hospital setting and to reflect postdischarge experiences of those who did and did not initiate XR-NTX treatment.
We used a convenience sampling strategy to identify study candidates, with the intention of recruiting approximately an equal number of medication-initiated and noninitiated patients. Study participants (N = 14) included 13 males and 1 female with OUD randomized to the XR-NTX arm of the X:BOT study at 1 of the 8 study sites. Seven participants in this sample initiated XR-NTX treatment, and seven did not. Each participant completed one semistructured qualitative interview. We analyzed transcripts using deductive and inductive approaches to conventional content analysis.
Although the majority of participants viewed opioid blockade, once-monthly dosing, and no dependence or withdrawal as favorable attributes of XR-NTX, participant ambivalence and lack of familiarity with antagonist treatment were barriers to treatment initiation. The long duration of action and the perceived "commitment" to the medication (e.g., "At the time, a month sounded like a year") compounded the patients' concerns and ambivalence. The majority of those who initiated XR-NTX described it as an effective treatment for OUD, with treatment satisfaction and sustained abstinence emerging as central themes among this population. Some participants who did not successfully initiate XR-NTX expressed regret and a willingness to try XR-NTX in the future.
Achieving full opioid detoxification is one, but not the only, barrier to initiating treatment with XR-NTX. Additional participant-identified barriers to XR-NTX initiation include fears and ambivalence regarding antagonist treatment. Once initiated, participants perceive XR-NTX to be an effective treatment for maintaining abstinence from opioids. XR-NTX appealed to participants due to the autonomy it affords with once-monthly dosing and no physical dependence.
由 Lee 等人（2018 年）进行的国家药物滥用治疗临床试验网络（CTN）多中心比较疗效研究（“X:BOT”）发现，一旦开始，纳曲酮延长释放剂（XR-NTX）与舌下丁丙诺啡-纳洛酮（BUP-NX）治疗阿片类药物使用障碍（OUD）同样安全有效。然而，戒毒的障碍使得 XR-NTX 的启动比 BUP-NX 困难得多。这一障碍突出表明需要更好地了解患者如何从阿片类药物的使用过渡到 XR-NTX 的治疗。
在住院环境下探讨患者在开始使用拮抗剂治疗（XR-NTX）时遇到的障碍和促进因素，并反映已开始和未开始 XR-NTX 治疗的患者出院后的经历。
我们采用便利抽样策略来确定研究对象，目的是在 X:BOT 研究的 8 个研究点之一的 XR-NTX 治疗组中招募数量大致相等的开始药物治疗的患者和未开始药物治疗的患者。本研究的参与者（N=14）包括 13 名男性和 1 名女性，他们患有 OUD，在 8 个研究点中的 1 个研究点被随机分配到 XR-NTX 组。在这个样本中，有 7 名参与者开始了 XR-NTX 治疗，有 7 名没有。每个参与者都完成了一次半结构化的定性访谈。我们使用演绎和归纳方法对常规内容分析进行了转录分析。
尽管大多数参与者认为阿片受体拮抗剂、每月一次的剂量和没有依赖或戒断是 XR-NTX 的有利属性，但参与者的矛盾心理和对拮抗剂治疗的不熟悉是治疗启动的障碍。作用时间长以及对药物的“承诺”（例如，“当时，一个月听起来像是一年”）增加了患者的担忧和矛盾心理。大多数开始使用 XR-NTX 的患者将其描述为治疗 OUD 的有效方法，治疗满意度和持续戒断是这一人群的核心主题。一些未能成功开始 XR-NTX 治疗的患者表示后悔，并表示愿意在未来尝试 XR-NTX。
实现完全阿片类药物脱毒是开始使用 XR-NTX 治疗的障碍之一，但不是唯一障碍。患者认为 XR-NTX 启动的其他障碍包括对拮抗剂治疗的恐惧和矛盾心理。一旦开始，参与者认为 XR-NTX 是一种有效的治疗方法，可以保持对阿片类药物的戒断。XR-NTX 每月一次的剂量和没有身体依赖使参与者感到自主，这对他们很有吸引力。
