Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.
Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
Can J Psychiatry. 2024 Apr;69(4):252-263. doi: 10.1177/07067437231210796. Epub 2023 Oct 30.
There is limited evidence on how opioid agonist treatment (OAT) may affect psychoactive non-opioid substance use in prescription-type opioid use disorder (POUD) and whether this effect might explain OAT outcomes. We aimed to assess the effect of methadone on non-opioid substance use compared to buprenorphine/naloxone (BUP/NX), to explore whether non-opioid substance use is associated with opioid use and retention in treatment, and to test non-opioid use as a moderator of associations between methadone with retention in OAT and opioid use compared to BUP/NX.
This is a secondary analysis of data from the OPTIMA trial, an open-label, pragmatic, parallel, two-arm, pan-Canadian, multicentre, randomized-controlled trial to compare standard methadone model of care and flexible take-home dosing BUP/NX for POUD treatment. We studied the effect of methadone and BUP/NX on non-opioid substance use evaluated by urine drug screen (UDS) and by classes of non-opioid substances (i.e., tetrahydrocannabinol [THC], benzodiazepines, stimulants) (weeks 2-24) using adjusted generalized estimation equation (GEE). We studied the association between non-opioid substance-positive UDS and opioid-positive UDS and retention in treatment, using adjusted GEE and logistic regressions.
Overall, methadone was not associated with non-opioid substance-positive UDS compared to BUP/NX (OR: 0.78; 95%CI, 0.41 to 1.48). When non-opioid substances were studied separately, methadone was associated with lower odds of benzodiazepine-positive UDS (OR: 0.63; 95% CI: 0.40 to 0.98) and THC-positive UDS (OR: 0.47; 95% CI: 0.28 to 0.77), but not with different odds of stimulant-positive UDS (OR: 1.29; 95% CI: 0.78 to 2.16) compared to BUP/NX. Substance-positive UDS, overall and separate classes, were not associated with opioid-positive UDS or retention in treatment.
Methadone did not show a significant effect on overall non-opioid substance use in POUD compared to BUP/NX treatment but was associated with lower odds of benzodiazepine and THC use in particular. Non-opioid substance use did not predict OAT outcomes. Further research is needed to ascertain whether specific patterns of polysubstance use (quantity and frequency) may affect treatment outcomes.
关于阿片类激动剂治疗（OAT）如何影响处方类阿片使用障碍（POUD）中的精神活性非阿片类物质使用，以及这种影响是否可以解释 OAT 结果，目前证据有限。我们旨在评估与丁丙诺啡/纳洛酮（BUP/NX）相比，美沙酮对非阿片类物质使用的影响，探索非阿片类物质使用是否与阿片类物质使用和治疗保留有关，并检验非阿片类物质使用作为美沙酮保留与 OAT 中阿片类物质使用的关联的调节因素，与 BUP/NX 相比。
这是对 OPTIMA 试验数据的二次分析，该试验是一项开放标签、实用、平行、双臂、全加拿大、多中心、随机对照试验，旨在比较标准美沙酮治疗模式和灵活的带回家丁丙诺啡/纳洛酮剂量（用于 POUD 治疗）。我们使用调整后的广义估计方程（GEE）评估了美沙酮和 BUP/NX 对尿药物筛查（UDS）和非阿片类物质（即四氢大麻酚[THC]、苯二氮䓬类、兴奋剂）类别中非阿片类物质使用的影响（第 2-24 周）。我们使用调整后的 GEE 和逻辑回归研究了非阿片类物质阳性 UDS 与阿片类物质阳性 UDS 与治疗保留之间的相关性。
总体而言，与 BUP/NX 相比，美沙酮与非阿片类物质阳性 UDS 无关（OR：0.78；95%CI，0.41 至 1.48）。当分别研究非阿片类物质时，美沙酮与苯二氮䓬类 UDS 阳性（OR：0.63；95%CI：0.40 至 0.98）和四氢大麻酚 UDS 阳性（OR：0.47；95%CI：0.28 至 0.77）的几率较低，但与兴奋剂 UDS 阳性的几率没有差异（OR：1.29；95%CI：0.78 至 2.16），与 BUP/NX 相比。总体而言，UDS 阳性物质和单独类别与阿片类物质阳性 UDS 或治疗保留无关。
与 BUP/NX 治疗相比，美沙酮在 POUD 中对总体非阿片类物质使用没有显示出显著影响，但与苯二氮䓬类和四氢大麻酚的使用几率较低有关。非阿片类物质使用不能预测 OAT 结果。需要进一步研究，以确定特定的多物质使用模式（数量和频率）是否会影响治疗结果。
