British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, British Columbia, V6Z 2A9, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.
British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, British Columbia, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
Drug Alcohol Depend. 2021 Nov 1;228:109006. doi: 10.1016/j.drugalcdep.2021.109006. Epub 2021 Aug 28.
Little is known about the relationship between opioid agonist therapy (OAT) and fentanyl use, specifically. This study aimed to estimate the association between current use of different forms of OAT, including methadone, buprenorphine/naloxone (BUP/NX), slow release oral morphine (SROM), or injectable opioid agonist treatment (iOAT), and the likelihood of a fentanyl-positive urine drug test (UDT) as compared to no OAT.
Data were obtained from three community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada from December 2016 through November 2018. Using multivariable Generalized Estimating Equations (GEE), we examined the association between current use of each form of OAT, as compared to no OAT, and fentanyl-positive UDT among participants who use opioids.
The 915 participants contributed 2112 UDTs over a median of two follow-up visits. The majority of UDTs (74.9 %) were positive for fentanyl. After adjustment for a priori defined confounding factors, compared to no OAT, current use of BUP/NX was associated with lower odds of fentanyl-positive UDT (odds ratio [OR] = 0.36, 95 % confidence interval [CI]: 0.22-0.58) while current use of methadone (OR = 0.84, 95 % CI: 0.65-1.07), iOAT (OR = 1.30, 95 % CI: 0.75-2.28), and SROM (OR = 1.34, 95 % CI: 0.74-2.43) were not.
In this cohort of people who use opioids in Vancouver, only use of BUP/NX was associated with lower odds of fentanyl-positive UDT. Our findings highlight high rates of ongoing fentanyl use despite the use of OAT and support the expansion of BUP/NX for the treatment of people who use fentanyl.
目前对于阿片类激动剂治疗（OAT）与芬太尼使用之间的关系知之甚少。本研究旨在评估当前使用不同形式的 OAT（包括美沙酮、丁丙诺啡/纳洛酮（BUP/NX）、口服缓释吗啡（SROM）或注射用阿片类激动剂治疗（iOAT））与芬太尼尿检阳性（UDT）的可能性之间的关联，与未接受 OAT 治疗者相比。
数据来自加拿大温哥华的三个社区招募的前瞻性吸毒人群队列研究，收集时间为 2016 年 12 月至 2018 年 11 月。采用多变量广义估计方程（GEE），我们检验了当前使用每种 OAT 形式（与未使用 OAT 相比）与使用阿片类药物的参与者中芬太尼尿检阳性之间的关联。
915 名参与者共进行了 2112 次 UDT，中位随访时间为两次。大多数 UDT（74.9%）呈芬太尼阳性。在调整了先验定义的混杂因素后，与未使用 OAT 相比，当前使用 BUP/NX 与芬太尼尿检阳性的可能性较低（比值比[OR] = 0.36，95%置信区间[CI]：0.22-0.58），而当前使用美沙酮（OR = 0.84，95%CI：0.65-1.07）、iOAT（OR = 1.30，95%CI：0.75-2.28）和 SROM（OR = 1.34，95%CI：0.74-2.43）无此关联。
在温哥华的这一阿片类药物使用者队列中，只有 BUP/NX 的使用与芬太尼尿检阳性的可能性降低有关。我们的研究结果突出表明，尽管使用了 OAT，但仍存在很高的芬太尼使用率，并支持扩大 BUP/NX 用于治疗芬太尼使用者。
