Oregon Health & Science University, Addiction Medicine Program, Portland, OR, United States.
CODA Treatment Program, Portland, OR, United States; Oregon Health & Science University, Department of Psychiatry, Portland, OR, United States.
Drug Alcohol Depend. 2021 Nov 1;228:109077. doi: 10.1016/j.drugalcdep.2021.109077. Epub 2021 Sep 20.
Associations between fentanyl use and initiation and retention on medications for opioid use disorder (MOUD) are poorly understood.
Data were from a multisite clinical trial comparing extended-release naltrexone (XR-NTX) with treatment as usual (TAU; buprenorphine or methadone) to achieve HIV viral suppression among people with OUD and uncontrolled HIV disease. The exposure of interest was fentanyl use, as measured by urine drug screening. Outcomes were time to MOUD initiation, defined as date of first injection of XR-NTX, buprenorphine prescription, or methadone administration; MOUD persistence, the total number of injections, prescriptions, or administrations received over 24 weeks; and MOUD retention, having an injection, prescription, or administration during weeks 20-24.
Participants (N = 111) averaged 47 years old and 62% were male. Just over half (57%) were Black and 13% were Hispanic. Sixty-four percent of participants tested positive for fentanyl at baseline. Participants with baseline fentanyl positivity were 11 times less likely to initiate XR-NTX than those negative for fentanyl (aHR = 0.09, 95% CI 0.03-0.24, p < .001), but there was no evidence that fentanyl use impacted the likelihood of TAU initiation (aHR = 1.50, 0.67-3.36, p = .323). Baseline fentanyl use was not associated with persistence or retention on any MOUD.
Fentanyl use was a substantial barrier to XR-NTX initiation for the treatment of OUD in persons with uncontrolled HIV infection. There was no evidence that fentanyl use impacted partial/full agonist initiation and, once initiated, retention on any MOUD.
芬太尼的使用与阿片类药物使用障碍（MOUD）药物的起始和维持之间的关系尚未被充分理解。
数据来自一项多中心临床试验，该试验比较了长效纳曲酮（XR-NTX）与常规治疗（丁丙诺啡或美沙酮），以实现患有 OUD 和未控制的 HIV 疾病的人群的 HIV 病毒抑制。感兴趣的暴露因素是芬太尼的使用，通过尿液药物筛查来衡量。结局指标是 MOUD 起始时间，定义为首次注射 XR-NTX、丁丙诺啡处方或美沙酮给药的日期；MOUD 维持时间，在 24 周内接受的注射、处方或给药次数；以及 MOUD 保留率，在第 20-24 周期间接受注射、处方或给药。
参与者（N=111）的平均年龄为 47 岁，62%为男性。超过一半（57%）为黑人，13%为西班牙裔。64%的参与者在基线时检测出芬太尼阳性。与芬太尼阴性的参与者相比，基线时芬太尼阳性的参与者起始 XR-NTX 的可能性低 11 倍（aHR=0.09，95%CI 0.03-0.24，p<0.001），但没有证据表明芬太尼的使用会影响 TAU 起始的可能性（aHR=1.50，0.67-3.36，p=0.323）。基线芬太尼的使用与任何 MOUD 的维持或保留均无关。
芬太尼的使用是 HIV 感染未得到控制的人群中开始使用 XR-NTX 治疗 OUD 的一个重要障碍。没有证据表明芬太尼的使用会影响部分/完全激动剂的起始，并且一旦起始，任何 MOUD 的保留率都不受影响。
