Jiang Xinyi, Guy Gery P, Dever Jill A, Richardson John S, Dunlap Laura J, Turcios Didier, Wolicki Sara Beth, Edlund Mark J, Losby Jan L
Division of Overdose Prevention, Centers for Disease Control and Prevention's National Center for Injury Prevention and Control, Atlanta, GA, USA.
RTI International, Washington, DC, USA.
Subst Use Addctn J. 2025 Apr;46(2):266-279. doi: 10.1177/29767342241266038. Epub 2024 Aug 14.
Opioid use disorder (OUD) affects millions of individuals each year in the United States. Patient retention in medications for opioid use disorder (MOUD) treatment is suboptimal. This study examines and quantifies the associations between each additional month of buprenorphine or methadone use and nonprescribed opioid use.
Data were obtained from an 18-month longitudinal, observational cohort study of patients (age ≥ 18 years) treated for OUD. Patients completed a baseline self-reported questionnaire between March 2018 and December 2019 and were asked to complete follow-up questionnaires at approximately 3-, 6-, 12-, and 18-months post-baseline until May 2021. Patients treated with buprenorphine or methadone, without taking other MOUD at least 12 months prior to baseline, were included. Outcomes included past 30-day use of prescription opioids nonmedically, heroin, or illegally made fentanyl. A multivariable, multilevel regression model with a binomial distribution and a logit link was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
This study included 353 patients taking buprenorphine (mean [standard deviation, SD] age 39 [11] years; 226 [64%] female), and 785 patients taking methadone (mean [SD] age 42 [12] years; 392 [50%] female). Each additional month of MOUD treatment was associated with a 25% decrease in the odds of past 30-day nonprescribed opioid use for patients taking buprenorphine (aOR [95% CI] = 0.75 [0.68-0.83]), and a 17% decrease for patients taking methadone (aOR = 0.83 [0.79-0.87]). The COVID-19 pandemic (aOR = 9.29 [2.96-29.17]; aOR = 3.19 [1.74-5.86]) and MOUD adverse reaction experiences (aOR = 3.07 [1.11-8.48]; aOR = 2.51 [1.01-6.22]) were significantly associated with higher odds of nonprescribed opioid use among buprenorphine and methadone groups.
Among patients treated with buprenorphine or methadone, with each additional treatment month since baseline, those who continued with treatment appeared to be more likely to report 17% to 25% decreased odds of past 30-day nonprescribed opioid use. Our findings can be used by clinicians in the shared decision-making process with patients, emphasizing the value of sustained retention in MOUD.
在美国，阿片类物质使用障碍（OUD）每年影响数百万个体。用于阿片类物质使用障碍（MOUD）治疗的药物的患者留存率并不理想。本研究调查并量化了丁丙诺啡或美沙酮使用增加的每个月与非处方阿片类物质使用之间的关联。
数据来自一项针对接受OUD治疗的患者（年龄≥18岁）的为期18个月的纵向观察性队列研究。患者在2018年3月至2019年12月期间完成了一份基线自我报告问卷，并被要求在基线后约3个月、6个月、12个月和18个月完成随访问卷，直至2021年5月。纳入在基线前至少12个月未服用其他MOUD且接受丁丙诺啡或美沙酮治疗的患者。结局包括过去30天非医疗用途的处方阿片类物质、海洛因或非法制造的芬太尼的使用情况。使用具有二项分布和对数链接的多变量、多层次回归模型来估计调整后的优势比（aOR）和95%置信区间（CI）。
本研究纳入了353例服用丁丙诺啡的患者（平均[标准差，SD]年龄39[11]岁；226例[64%]为女性），以及785例服用美沙酮的患者（平均[SD]年龄42[12]岁；392例[50%]为女性）。对于服用丁丙诺啡的患者，MOUD治疗增加的每个月与过去30天非处方阿片类物质使用几率降低25%相关（aOR[95%CI]=0.75[0.68 - 0.83]），对于服用美沙酮的患者，该几率降低17%（aOR = 0.83[0.79 - 0.87]）。2019冠状病毒病大流行（aOR = 9.29[2.96 - 29.17]；aOR = 3.19[1.74 - 5.86]）和MOUD不良反应经历（aOR = 3.07[1.11 - 8.48]；aOR = 2.51[1.01 - 6.22]）与丁丙诺啡和美沙酮组中非处方阿片类物质使用几率较高显著相关。
在接受丁丙诺啡或美沙酮治疗的患者中，自基线起每增加一个治疗月，继续治疗的患者报告过去30天非处方阿片类物质使用几率降低17%至25%的可能性似乎更高。我们的研究结果可供临床医生在与患者的共同决策过程中使用，强调持续留存于MOUD治疗的价值。
