British Columbia Centre on Substance Use, Vancouver, BC, Canada.
Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Can J Psychiatry. 2024 Mar;69(3):172-182. doi: 10.1177/07067437231194385. Epub 2023 Sep 12.
BACKGROUND: Prescription-type opioid use disorder (POUD) is often accompanied by comorbid anxiety, yet the impact of anxiety on retention in opioid agonist therapy (OAT) is unclear. Therefore, this study investigated whether baseline anxiety severity affects retention in OAT and whether this effect differs by OAT type (methadone maintenance therapy (MMT) vs. buprenorphine/naloxone (BNX)). METHODS: This secondary analysis used data from a pan-Canadian randomized trial comparing flexible take-home dosing BNX and standard supervised MMT for 24 weeks. The study included 268 adults with POUD. Baseline anxiety was assessed using the Beck Anxiety Inventory (BAI), with BAI ≥ 16 indicating moderate-to-severe anxiety. The primary outcomes were retention in assigned and any OAT at week 24. In addition, the impact of anxiety severity on retention was examined, and assigned OAT was considered an effect modifier. RESULTS: Of the participants, 176 (65%) reported moderate-to-severe baseline anxiety. In adjusted analyses, there was no significant difference in retention between those with BAI ≥ 16 and those with BAI < 16 assigned (29% vs. 28%; odds ratio (OR) = 2.03, 95% confidence interval (CI) = 0.94-4.40; = 0.07) or any OAT (35% vs. 34%; OR = 1.57, 95% CI = 0.77-3.21; = 0.21). In addition, there was no significant effect modification by OAT type for retention in assigned ( = 0.41) or any OAT ( = 0.71). In adjusted analyses, greater retention in treatment was associated with BNX (vs. MMT), male gender identity (vs. female, transgender, or other), enrolment in the Quebec study site (vs. other sites), and absence of a positive urine drug screen for stimulants at baseline. CONCLUSIONS: Baseline anxiety severity did not significantly impact retention in OAT for adults with POUD, and there was no significant effect modification by OAT type. However, the overall retention rates were low, highlighting the need to develop new strategies to minimize the risk of attrition from treatment. CLINICAL TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov (NCT03033732).
背景：处方类阿片类药物使用障碍（POUD）常伴有共病性焦虑，但焦虑对阿片类药物激动剂治疗（OAT）的保留率的影响尚不清楚。因此，本研究调查了基线焦虑严重程度是否会影响 OAT 的保留率，以及这种影响是否因 OAT 类型（美沙酮维持治疗（MMT）与丁丙诺啡/纳洛酮（BNX））而异。
方法：本二次分析使用了一项全加比较灵活的家庭剂量 BNX 与标准监督 MMT 24 周的随机试验的数据。该研究纳入了 268 名 POUD 成年人。使用贝克焦虑量表（BAI）评估基线焦虑，BAI≥16 表示中重度焦虑。主要结局为 24 周时分配的 OAT 和任何 OAT 的保留率。此外，还检查了焦虑严重程度对保留率的影响，并认为分配的 OAT 是一个效应修饰剂。
结果：在参与者中，176 人（65%）报告基线存在中重度焦虑。在调整后的分析中，BAI≥16 和 BAI<16 组之间的保留率没有显著差异（29%比 28%；比值比（OR）=2.03，95%置信区间（CI）=0.94-4.40； = 0.07）或任何 OAT（35%比 34%；OR=1.57，95% CI=0.77-3.21； = 0.21）。此外，OAT 类型对分配的保留率（ = 0.41）或任何 OAT（ = 0.71）均无显著的效应修饰作用。在调整后的分析中，治疗的保留率与 BNX（与 MMT 相比）、男性性别认同（与女性、跨性别或其他性别相比）、在魁北克研究地点入组（与其他地点相比）以及基线时尿药物筛查无兴奋剂阳性有关。
结论：基线焦虑严重程度对 POUD 成年人的 OAT 保留率没有显著影响，且 OAT 类型无显著的效应修饰作用。然而，总体保留率较低，这突出表明需要制定新策略，以最大限度地降低治疗中断的风险。
临床试验注册：本研究在 ClinicalTrials.gov 注册（NCT03033732）。
Adv Drug Alcohol Res. 2021
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