Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul, Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada.
Drug Alcohol Depend. 2022 Oct 1;239:109604. doi: 10.1016/j.drugalcdep.2022.109604. Epub 2022 Aug 17.
Craving reduction is an important target in the treatment of prescription-type opioid use disorder (POUD). In this exploratory analysis, we compared the effectiveness of BUP/NX flexible model of care relative to methadone for craving reduction in individuals with POUD.
We analyzed data from a multicentric, pragmatic, 24-week open-label randomized controlled trial conducted in participants with POUD (N = 272) who were randomly assigned to BUP/NX model of care with flexible take-home dosing (n = 138) or the standard model of care with closely supervised methadone (n = 134). Treatments were prescribed and administered according to local guidelines, in diverse clinical settings. Craving was measured using the Brief Substance Craving Scale at baseline, week 2, 6, 10, 14, 18 and 22.
Cravings decreased in both treatment groups over 22 weeks (BUP/NX adjusted mean difference = -5.52, 95% CI = -6.91 to -4.13; methadone adjusted mean difference = -3.95, 95% CI = -5.28 to -2.63; p < 0.001), and were overall lower in the BUP/NX group (adjusted mean = 4.04, 95% CI = 3.43-4.64) than the methadone group (adjusted mean = 5.13, 95% CI = 4.51-5.74; p < 0.001). The time by treatment group interaction (favoring BUP/NX) was statistically significant at week 2 (adjusted mean difference = -1.58, 95% CI = -3.13 to -0.03; p = 0.041).
Compared to the standard methadone model of care, flexible take-home dosing of BUP/NX was associated with lower craving in individuals with POUD. These findings can contribute to guiding shared decision-making regarding OAT treatment in this population.
减少渴望是治疗处方类阿片类药物使用障碍（POUD）的重要目标。在这项探索性分析中，我们比较了 BUP/NX 灵活治疗模式相对于美沙酮对 POUD 患者减少渴望的疗效。
我们分析了一项多中心、实用、24 周开放性随机对照试验的数据，该试验纳入了 272 名 POUD 患者（N=272），他们被随机分配到 BUP/NX 灵活带药治疗模式（n=138）或标准美沙酮治疗模式（n=134）。根据当地指南，在不同的临床环境中，为患者开出并管理治疗方案。在基线、第 2、6、10、14、18 和 22 周时使用简短物质渴望量表测量渴望。
两组患者在 22 周内的渴望均有所下降（BUP/NX 调整平均差异=-5.52，95%CI=-6.91 至-4.13；美沙酮调整平均差异=-3.95，95%CI=-5.28 至-2.63；p<0.001），BUP/NX 组的渴望总体较低（调整均值=4.04，95%CI=3.43-4.64），美沙酮组的渴望较高（调整均值=5.13，95%CI=4.51-5.74；p<0.001）。治疗组间的时间交互作用（有利于 BUP/NX）在第 2 周时具有统计学意义（调整平均差异=-1.58，95%CI=-3.13 至-0.03；p=0.041）。
与标准美沙酮治疗模式相比，BUP/NX 灵活带药治疗与 POUD 患者较低的渴望相关。这些发现可以为指导该人群 OAT 治疗的共同决策提供依据。
