From the Yale School of Medicine, New Haven, CT (MJ); Department of Biostatistics, Brown University, Providence, RI (JS); New York Psychiatric Institute, New York, NY (JS); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY (MP); Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY (T-HC); New York State Psychiatric Institute, New York, NY (MG, OO, EVN); Columbia Irving Medical Center, New York, NY (MG, EVN); Department of Psychiatry, Yale School of Medicine, New Haven, CT (TGR, AH); VA New England Mental Illness, Research, Education, and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT (TGR); NYU Grossman School of Medicine, New York, NY (JR); Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (KH); Yale School of Public Health, New Haven, CT (KH, EJE); Program in Addiction Medicine, Yale School of Medicine, New Haven, CT (KH, EJE); Department of Internal Medicine, Yale School of Medicine, New Haven, CT (EJE).
J Addict Med. 2023;17(4):463-467. doi: 10.1097/ADM.0000000000001125. Epub 2023 Jan 5.
We sought to identify the sociodemographic and clinical characteristics associated with homelessnesss, and explore the relationship between homelessnesss and treatment outcomes among Black individuals.
This is a secondary analysis of the subgroup of Black participants (n = 73) enrolled in "X:BOT," a 24-week multisite randomized clinical trial comparing the effectiveness of extended-release naltrexone versus sublingual buprenorphine-naloxone (n = 570). Outcomes included medication initiation, return to extramedical use of opioids assessed by both self-report and urine toxicology, and engagement in medications for opioid use disorder (MOUD) treatment at 28 weeks postrandomization. Descriptive statistics were performed.
Black participants were mostly unmarried and male, and about a third were aged 21-30 years. Among people experiencing homelessnesss, more were uninsured (45.5% [10/22] vs 19.6% [10/51]), unemployed (77.3% [17/22] vs 64.7% [33/51]), and reported alcohol (40.9% [9/22] vs 23.5% [12/51]) and sedative use (54.5% [12/22] vs 17.6% [9/51]) within the previous 30 days. Compared with housed Black individuals, a slightly higher proportion of Black individuals experiencing homelessnesss successfully initiated study medication (81.1% [18/22] vs 72.6% [37/51]); similar proportions returned to opioid use during the trial (68.2% [15/22] vs 68.6% [35/51]) and were engaged in MOUD at 28 weeks after trial entry (72.2% [13/18] vs 69.7% [23/33]) among participants located for follow-up.
These descriptive results among Black patients participating in a trial of MOUD suggest that efficacious MOUD is possible despite homelessnesss with additional clinical supports such as those provided by a clinical trial.
我们旨在确定与无家可归相关的社会人口学和临床特征，并探讨无家可归与黑人个体治疗结果之间的关系。
这是一项针对“X:BOT”研究中黑人参与者亚组（n=73）的二次分析，该研究是一项为期 24 周的多地点随机临床试验，比较了延长释放型纳曲酮与舌下丁丙诺啡-纳洛酮（n=570）的有效性。结果包括药物起始、通过自我报告和尿液毒理学评估的阿片类药物再使用、以及在随机分组后 28 周接受阿片类药物使用障碍（MOUD）治疗的药物使用情况。进行了描述性统计分析。
黑人参与者主要为未婚男性，约三分之一年龄在 21-30 岁之间。在无家可归者中，更多人没有保险（45.5%[10/22]比 19.6%[10/51]）、失业（77.3%[17/22]比 64.7%[33/51]），并在过去 30 天内报告使用酒精（40.9%[9/22]比 23.5%[12/51]）和镇静剂（54.5%[12/22]比 17.6%[9/51]）。与有住房的黑人相比，略高比例的无家可归黑人成功启动研究药物（81.1%[18/22]比 72.6%[37/51]）；在试验期间，返回使用阿片类药物的比例相似（68.2%[15/22]比 68.6%[35/51]），在试验进入后 28 周接受 MOUD 的比例相似（72.2%[13/18]比 69.7%[23/33]）。
这些针对参与 MOUD 试验的黑人患者的描述性结果表明，尽管存在无家可归等额外的临床支持，如临床试验提供的支持，但有效的 MOUD 是可能的。
