Shouan Anish, Ghosh Abhishek, Singh Shubh Mohan, Basu Debasish, Mattoo Surendra Kumar
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Psychiatry. 2021 Jul-Aug;63(4):355-365. doi: 10.4103/psychiatry.IndianJPsychiatry_448_20. Epub 2021 Aug 7.
Literature on a longitudinal study of the determinants of treatment retention for patients with opioid dependence is limited.
To find out patient- and treatment-related (buprenorphine-naloxone-assisted treatment [BNX treatment] versus naltrexone treatment) predictors for retention in maintenance treatment.
A total of 100 participants with opioid dependence were recruited by convenience sampling. The primary outcome was treatment retention - 3 months and 6 months postentry into maintenance treatment. Multiple assessments were done for the severity of opioid dependence and withdrawal, high-risk behavior, quality of life, and recovery capital - baseline and 3 and 6 months. The secondary outcome was to assess the change observed in the above-listed variables.
Bivariate analysis across retained and the dropout groups brought out significant differences for some (type of opioids and route of administration) but not for other (age, employment, and education) patient-related factors. Multivariate analysis, adjusting for the type of maintenance treatment, rendered these associations statistically insignificant. BNX-based treatment (compared to naltrexone maintenance) was the most significant predictor of treatment retention both at the end of 3 months and 6 months. Even after controlling for the severity of opioid dependence and withdrawal, type and route of opioid use, and high-risk behavior, patients on BNX were eleven times (14 times at the end of 6 months) more likely to be retained in the treatment. BNX group had significant improvements in the domains of recovery capital, quality of life, addiction severity, and severity of opioid dependence. There is a need to scale up the BNX-assisted treatment program in India and elsewhere.
关于阿片类药物依赖患者治疗留存决定因素的纵向研究文献有限。
找出与患者及治疗相关的（丁丙诺啡 - 纳洛酮辅助治疗[BNX治疗]与纳曲酮治疗相比）维持治疗留存的预测因素。
通过便利抽样招募了100名阿片类药物依赖参与者。主要结局是治疗留存——进入维持治疗后3个月和6个月。对阿片类药物依赖和戒断的严重程度、高危行为、生活质量及康复资本进行了多次评估——基线时以及3个月和6个月时。次要结局是评估上述列出变量中观察到的变化。
留存组和退出组之间的双变量分析显示，一些与患者相关的因素（阿片类药物类型和给药途径）存在显著差异，但其他因素（年龄、就业和教育）没有。在调整维持治疗类型后进行的多变量分析使这些关联在统计学上不显著。基于BNX的治疗（与纳曲酮维持治疗相比）是3个月和6个月末治疗留存的最显著预测因素。即使在控制了阿片类药物依赖和戒断的严重程度、阿片类药物使用类型和途径以及高危行为之后，接受BNX治疗的患者被留存于治疗中的可能性仍是11倍（6个月末为14倍）。BNX组在康复资本、生活质量、成瘾严重程度和阿片类药物依赖严重程度方面有显著改善。有必要在印度和其他地方扩大BNX辅助治疗项目。
