College of Health Solutions, Arizona State University, Phoenix, AZ, United States of America.
Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, United States of America; Department of Psychiatry, Boonshoft School of Medicine, Wright State University, United States of America.
J Subst Use Addict Treat. 2023 Apr;147:208973. doi: 10.1016/j.josat.2023.208973. Epub 2023 Feb 10.
With the increasing use of non-prescribed buprenorphine (NPB), we need more data to identify the longitudinal patterns of NPB use. The goal of this natural history study is to characterize heterogeneity in trajectories of NPB, other opioid use, and participation in medication for opioid disorder (MOUD) treatment among a community-recruited sample of individuals with current opioid use disorder (OUD).
The study recruited a community-based sample of 357 individuals with OUD who used NPB in the past 6 months in Ohio, United States, for baseline and follow-up assessments (every 6 months for 2 years) of drug use, treatment participation, and other health and psychosocial characteristics. The study used multiple imputation to handle missing data. We used a multi-trajectory latent class growth analysis (MT-LCGA) to find salient groupings of participants based on the trajectories of NPB, other opioid use, and treatment participation.
Over time, NPB use frequency declined from a mean of 14.6 % of days at baseline to 3.6 % of days at 24-month follow-up along with declines in heroin/fentanyl (56.4 % to 23.6 % of days) and non-prescribed pharmaceutical opioid (NPPO) use (11.6 % to 1.5 % of days). Participation in MOUD treatment increased from a mean of 17.0 % of days at baseline to 52.4 % of days at 24 months. MT-LCGA identified a 6-class model. All six classes showed declines in NPB use. Class 1 (28 %) was characterized by high and increasing MOUD treatment utilization. Class 2 (21 %) showed sustained high levels of heroin/fentanyl use and had the lowest levels of NPB use (2.2 % of days) at baseline. Class 3 (3 %) was characterized as the primary NPPO use group. Class 4 (5 %) transitioned from high levels of NPB use to increased MOUD treatment utilization. It had the highest levels of NPB use at baseline (average of 80.7 % of days) that decreased to an average of 12.9 % of days at 24 months. Class 5 (16 %) showed transition from high levels of heroin/fentanyl use to increased MOUD treatment utilization. Class 6 (27 %) showed decreased heroin/fentanyl use over time and low MOUD treatment utilization. Classes showed varying levels of improvement in psychosocial functioning, polydrug use, and overdose risks.
Overall, our findings suggest that NPB use was generally self-limiting with individuals reducing their use over time as some engage in greater utilization of MOUD treatment. A need exists for continuing improvements in MOUD treatment access and retention.
随着非处方丁丙诺啡（NPB）的使用不断增加，我们需要更多的数据来确定 NPB 使用的纵向模式。本自然史研究的目的是描述社区招募的当前阿片类药物使用障碍（OUD）个体中，NPB 使用、其他阿片类药物使用和参与药物治疗阿片类药物障碍（MOUD）治疗的轨迹的异质性。
该研究在美国俄亥俄州招募了 357 名有 OUD 的社区参与者，他们在过去 6 个月中使用了 NPB，用于药物使用、治疗参与和其他健康和社会心理特征的基线和随访评估（每 6 个月 2 年）。该研究使用多重插补来处理缺失数据。我们使用多轨迹潜在类别增长分析（MT-LCGA）根据 NPB、其他阿片类药物使用和治疗参与的轨迹来发现参与者的显著分组。
随着时间的推移，NPB 使用频率从基线时的平均 14.6%的天数下降到 24 个月随访时的 3.6%，同时海洛因/芬太尼（56.4%降至 23.6%）和非处方药物阿片类药物（NPPO）使用（11.6%降至 1.5%）下降。MOUD 治疗的参与率从基线时的平均 17.0%上升到 24 个月时的 52.4%。MT-LCGA 确定了一个 6 类模型。所有 6 类均显示 NPB 使用减少。第 1 类（28%）的特点是 MOUD 治疗利用率高且不断增加。第 2 类（21%）表现为持续高水平的海洛因/芬太尼使用，且 NPB 使用量最低（基线时为 2.2%的天数）。第 3 类（3%）为主要 NPPO 使用组。第 4 类（5%）从高水平 NPB 使用转变为增加 MOUD 治疗利用率。它在基线时的 NPB 使用量最高（平均 80.7%的天数），下降到 24 个月时的平均 12.9%的天数。第 5 类（16%）表现为从高水平海洛因/芬太尼使用转变为增加 MOUD 治疗利用率。第 6 类（27%）显示海洛因/芬太尼使用随时间减少，MOUD 治疗利用率低。各阶层在社会心理功能、多药使用和过量风险方面都有不同程度的改善。
总体而言，我们的研究结果表明，NPB 的使用通常是自我限制的，随着时间的推移，个体减少使用量，因为一些人更多地参与 MOUD 治疗。需要不断改善 MOUD 治疗的可及性和保留率。
