Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
Unité de recherche Clinique appliquée (URCA), Research Centre, Centre Hospitalier Ste-Justine, 3175 chemin de la Côte Ste-Catherine, Montréal, Québec H3T 1C5, Canada.
Addict Behav. 2024 Jul;154:108023. doi: 10.1016/j.addbeh.2024.108023. Epub 2024 Mar 27.
The relationship between opioid craving and opioid use is unclear. We sought to determine to what extent craving mediated the relationship between opioid agonist therapy and changes in opioid use.
Data came from a pragmatic, 24-week, pan-Canadian, multi-centric, open-label, randomized controlled trial comparing flexible buprenorphine/naloxone take-home doses to standard supervised methadone models of care for the treatment of prescription-type opioid use disorder. Participants were randomly allocated to buprenorphine/naloxone or methadone models of care. 270 people with prescription-type opioid use disorder were included in analyses. There were 93 women (34.4%) and 2 transgender (0.7%) participants. Most participants were white (67.4%), 45.9% reported unstable living conditions, and 44.8% had psychiatric comorbidities. Generalized linear mixed models followed by mediation analysis estimated the direct effect of treatment group on Timeline Followback-reported next-week opioid use and the indirect effect through past 24-hour opioid craving measured using the Brief Substance Craving Scale at week 2, 6, 10, 14, 18 and 22.
Upon mediation analysis, the average direct effect of treatment on opioid use was 0.465 (95 % CI = 0.183 to 0.751, p < 0.001). The average causal mediated effect was 0.144 (95 % CI = 0.021 to 0.110; p < 0.001). Craving accounted for 23.6 % of the effect of treatment on opioid use (p < 0.001).
Past 24-hour craving was associated with increased next-week opioid use; however, craving only partially mediated the effect of buprenorphine/naloxone and methadone on next-week opioid use. Research is needed to develop a comprehensive understanding of factors mediating opioid use during opioid agonist therapy.
阿片类药物渴求与阿片类药物使用之间的关系尚不清楚。我们旨在确定在多大程度上，渴求能够介导阿片类激动剂治疗与阿片类药物使用变化之间的关系。
数据来自一项实用的、为期 24 周、全加拿大范围的、多中心、开放性、随机对照试验，该试验比较了灵活的丁丙诺啡/纳洛酮带药回家剂量与标准监督美沙酮治疗方案，用于治疗处方类阿片类药物使用障碍。参与者被随机分配到丁丙诺啡/纳洛酮或美沙酮治疗方案。共有 270 名患有处方类阿片类药物使用障碍的患者被纳入分析。其中有 93 名女性（34.4%）和 2 名跨性别者（0.7%）。大多数参与者为白人（67.4%），45.9%报告生活状况不稳定，44.8%有精神共病。使用广义线性混合模型，然后进行中介分析，估计治疗组对 Timeline Followback 报告的下周阿片类药物使用的直接影响，以及通过在第 2、6、10、14、18 和 22 周使用 Brief Substance Craving Scale 测量的过去 24 小时阿片类药物渴求来测量的间接影响。
在中介分析中，治疗对阿片类药物使用的平均直接效应为 0.465（95%CI=0.183 至 0.751，p<0.001）。平均因果中介效应为 0.144（95%CI=0.021 至 0.110；p<0.001）。渴求占治疗对阿片类药物使用影响的 23.6%（p<0.001）。
过去 24 小时的渴求与下周阿片类药物使用增加有关；然而，渴求仅部分中介了丁丙诺啡/纳洛酮和美沙酮对下周阿片类药物使用的影响。需要研究来全面了解阿片类激动剂治疗期间中介阿片类药物使用的因素。
