Department of Psychiatry, Dalhousie University, 810 Maplewood Lane, Halifax, NS, B3H 4k3, Canada.
Department of Medicine, Dalhousie University, Halifax, NS, Canada.
BMC Psychiatry. 2022 Jul 30;22(1):516. doi: 10.1186/s12888-022-04175-9.
The last decade has shown a remarkable increase in the rates of illicit opioid use in Canada and internationally, which is associated with large increases in opioid related morbidity and mortality. While the differences between methadone and buprenorphine/naloxone in terms of retention have been studied outside Canada, the unique location and design of this study, gives it a specific significance.
This study aims to describe the relative treatment retention rates for first episode opioid replacement treatment between methadone and buprenorphine/naloxone for patients receiving daily witnessed dispensed medications in Nova Scotia.
A longitudinal retrospective descriptive study analyzing secondary data from the Nova Scotia Prescription Monitoring Program on patients 18 years of age and older who started first episode opioid agonist therapy with methadone or buprenorphine/naloxone for opioid use disorder in Nova Scotia between 2014 and 2018. Treatment episode was defined as date of initial opioid agonist prescription until there is a gap of greater than 6 days without receiving opioid agonist medication at a pharmacy.
One thousand eight hundred sixty-seven of whom were analyzed as they had at least 1 day in treatment. There was significant treatment dropout within the first 2 weeks of treatment, which did not show a significant difference between OAT medication (23.4% of buprenorphine/naloxone; 22.2% methadone). Median duration of retention in treatment was 58 days for those treated with buprenorphine/naloxone and 101 days for patients treated with methadone. Multivariate cox proportional hazards model showed that buprenorphine/naloxone use as compared to methadone lead to increased hazard of treatment dropout by 62% (HR = 1.62). Hazard rate of treatment dropout for patients below 25 years of age was calculated. (HR 1.53). Median duration of retention in treatment for this subgroup of patients younger than age 25 was 37.5 days for patients treated with buprenorphine/naloxone and 69 days for patients treated with methadone.
Our data suggests that methadone is a numerically superior medication for opioid use disorder when the metric of treatment retention is viewed in isolation, for our population in Nova Scotia. However, the results should be interpreted carefully considering the number of limitations of this study. There are social/accessibility, pharmacologic/safety, and patient preference factors which are also key in decision making when prescribing opioid agonist therapy. These must all be considered when deciding on which medication to initiate for a patient beginning a new treatment episode with OAT for opioid use disorder. This study should stimulate further research into this important area in addiction medicine.
过去十年，加拿大和国际上非法阿片类药物的使用率显著上升，这与阿片类药物相关发病率和死亡率的大幅上升有关。虽然在加拿大以外的地方已经研究了美沙酮和丁丙诺啡/纳洛酮在保留方面的差异，但这项研究的独特地点和设计使其具有特殊意义。
本研究旨在描述新斯科舍省接受每日观察配药的首诊阿片类药物替代治疗患者中，美沙酮和丁丙诺啡/纳洛酮治疗的相对保留率。
这是一项纵向回顾性描述性研究，分析了新斯科舍省处方监测计划中的二级数据，该计划纳入了 2014 年至 2018 年间在新斯科舍省因阿片类药物使用障碍首次接受美沙酮或丁丙诺啡/纳洛酮阿片类激动剂治疗的年龄在 18 岁及以上的患者。治疗期定义为首次开具阿片类激动剂处方至在药房停止接受阿片类激动剂药物治疗超过 6 天的时间。
1867 名患者被纳入分析，因为他们至少有 1 天的治疗时间。在治疗的前 2 周内有明显的治疗中断，丁丙诺啡/纳洛酮和美沙酮之间的药物治疗中断率没有显著差异（丁丙诺啡/纳洛酮：23.4%；美沙酮：22.2%）。接受丁丙诺啡/纳洛酮治疗的患者中位治疗保留期为 58 天，接受美沙酮治疗的患者中位治疗保留期为 101 天。多变量 Cox 比例风险模型显示，与美沙酮相比，丁丙诺啡/纳洛酮的治疗中断风险增加了 62%（HR=1.62）。计算了年龄在 25 岁以下患者的治疗中断风险率。（HR 1.53）。年龄小于 25 岁的患者中，接受丁丙诺啡/纳洛酮治疗的患者中位治疗保留期为 37.5 天，接受美沙酮治疗的患者中位治疗保留期为 69 天。
我们的数据表明，在新斯科舍省的人群中，当仅从治疗保留的角度来看，美沙酮是治疗阿片类药物使用障碍的一种在数值上更优越的药物。然而，应该谨慎解释研究的结果，因为它存在许多局限性。在为阿片类药物使用障碍开始新的治疗阶段的患者开阿片类激动剂治疗药物时，还有社会/可及性、药理学/安全性和患者偏好等因素，这些因素在决策中也很重要。在决定启动哪种药物治疗时，这些因素都必须加以考虑。本研究应激发进一步研究这一重要的成瘾医学领域。
