Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
Department of Biostatistics, University of Washington, Seattle, WA, USA.
Am J Drug Alcohol Abuse. 2023 Jul 4;49(4):511-518. doi: 10.1080/00952990.2023.2220876. Epub 2023 Jun 27.
Buprenorphine is a partial mu opioid agonist medication that has been shown to decrease non-prescribed opioid use, cravings, and opioid related morbidity and mortality. There is an assumption that full adherence is needed to achieve ideal treatment outcomes, and that non-adherence is associated with ongoing opioid use. However, literature documenting the strength of that assertion is lacking. Evaluate the association between daily buprenorphine adherence and illicit opioid use. Secondary analysis of a 12-week randomized controlled trial of adults with opioid use disorder who recently initiated buprenorphine. Weekly study visits included self-report of daily buprenorphine adherence over the past 7 days (Timeline Follow Back method) and urine drug tests (UDT). A log-linear regression model accounting for clustering by participant was used to assess the association between buprenorphine adherence and illicit opioid use. Buprenorphine adherence was measured as a continuous variable (0-7 days). Among 78 participants (56 men, 20 women, 2 nonbinary) with 737 visits, full 7-day adherence was reported at 70% of visits. The predominant form of non-adherence was missed doses (92% of cases). Each additional day of adherence was associated with an 8% higher rate of negative UDT for illicit opioids (RR = 1.08; 95% CI:1.03-1.13, = .0002). In this sample of participants starting buprenorphine, missed doses were not uncommon. Fewer missed days was significantly associated with a lower risk of illicit opioid use. These findings suggest that efforts to minimize the number of missed days of buprenorphine are beneficial for treatment outcomes.
丁丙诺啡是一种部分μ阿片类激动剂药物，已被证明可减少非处方阿片类药物的使用、渴望和阿片类药物相关的发病率和死亡率。人们假设需要完全遵守才能实现理想的治疗结果，而且不遵守与持续使用阿片类药物有关。然而，缺乏记录这一说法的文献。评估丁丙诺啡每日依从性与非法阿片类药物使用之间的关系。对最近开始使用丁丙诺啡的阿片类药物使用障碍成年人进行的为期 12 周的随机对照试验的二次分析。每周的研究访问包括过去 7 天内每天丁丙诺啡依从性的自我报告（时间线回溯法）和尿液药物测试（UDT）。使用考虑参与者聚类的对数线性回归模型来评估丁丙诺啡依从性与非法阿片类药物使用之间的关联。丁丙诺啡依从性作为连续变量（0-7 天）进行测量。在 78 名参与者（56 名男性，20 名女性，2 名非二进制）中，有 737 次就诊，70%的就诊报告了完全 7 天的依从性。主要的不依从形式是漏服（92%的病例）。每增加一天的依从性，非法阿片类药物的 UDT 阴性率就会增加 8%（RR=1.08；95%CI：1.03-1.13，=0.0002）。在开始使用丁丙诺啡的这个参与者样本中，漏服并不少见。漏服天数越少，非法阿片类药物使用的风险越低。这些发现表明，努力减少丁丙诺啡漏服天数有利于治疗结果。
