Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
Eur Addict Res. 2022;28(1):56-67. doi: 10.1159/000518436. Epub 2021 Sep 24.
Extended-release naltrexone (XR-NTX) is effective for illicit opioid abstinence as an opioid maintenance treatment. To improve treatment outcomes, patient's preference for the modality of treatment is an important factor.
We aimed to test the relationship between baseline preference for XR-NTX and adherence to treatment, use of illicit opioids, and risk of relapse.
In an open-label, Norwegian clinical trial participants with opioid use disorder were randomized to either monthly injections with XR-NTX or daily sublingual buprenorphine-naloxone (BP-NLX) for 12 weeks. Subsequently, participants could continue with their preferred medication in a 36-week follow-up and in a prolonged period of 104 weeks.
Of 153 participants who completed detoxification, 72% were men, with a mean age of 36 years. Preference levels were similar across the randomized groups, with no significant associations between preference and adherence to treatment, opioid use, or relapse. The BP-NLX group had a significantly higher risk of first relapse to opioids than the XR-NTX group for all levels of preference (p < 0.001) and a significantly higher number of days of illicit opioid use. In the follow-up period, the adherence rate was twice as high among participants with the highest preference compared to participants with the lowest preference, both among those who switched to XR-NTX and those who continued (hazard ratio 2.2; 1.2-4.0, p = 0.013). Opioid use was significantly higher among participants who switched to XR-NTX with the lowest preference than the medium (p = 0.003) or the highest (p = 0.001) preference. The risk of relapse to opioids, however, was significantly higher among XR-NTX continuing participants with the lowest (p = 0.002) or the medium (p = 0.043) preference than those with the highest preference.
Individuals who matched with their preferred treatment used less illicit opioids than those who did not during short-term treatment. However, baseline preference for XR-NTX treatment primarily influenced longer term opioid use and treatment adherence.
缓释型纳曲酮（XR-NTX）作为阿片类药物维持治疗，对非法阿片类药物戒断有效。为了改善治疗效果，患者对治疗方式的偏好是一个重要因素。
我们旨在检验基线时对 XR-NTX 的偏好与治疗依从性、非法阿片类药物使用和复发风险之间的关系。
在一项开放性标签、挪威临床试验中，患有阿片类药物使用障碍的参与者被随机分配到每月接受 XR-NTX 注射或每日舌下给予丁丙诺啡-纳洛酮（BP-NLX）治疗 12 周。随后，参与者可以在 36 周的随访期和 104 周的延长期间继续使用他们首选的药物。
在完成戒毒的 153 名参与者中，72%为男性，平均年龄为 36 岁。随机分组之间的偏好水平相似，偏好与治疗依从性、阿片类药物使用或复发之间没有显著关联。在所有偏好水平下，BP-NLX 组的首次复吸阿片类药物的风险均显著高于 XR-NTX 组（p < 0.001），且非法阿片类药物使用天数也显著更高。在随访期间，与最低偏好者相比，最高偏好者的依从率是后者的两倍，无论是转用 XR-NTX 者还是继续使用者（风险比 2.2；1.2-4.0，p = 0.013）。与具有中等偏好或最高偏好者相比，转用 XR-NTX 且偏好最低者的阿片类药物使用量显著更高（p = 0.003）。然而，与具有最高偏好者相比，继续使用 XR-NTX 且偏好最低或中等者的复吸阿片类药物的风险更高（p = 0.002）。
在短期治疗中，与首选治疗相匹配的个体比不匹配者使用非法阿片类药物更少。然而，基线时对 XR-NTX 治疗的偏好主要影响长期阿片类药物使用和治疗依从性。
