Bailey Allen J, Votaw Victoria R, Weiss Roger D, McHugh R Kathryn
Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts.
JAMA Psychiatry. 2025 Feb 1;82(2):201-203. doi: 10.1001/jamapsychiatry.2024.3836.
Reliance on abstinence-based treatment success rules may fail to capture the full continuum of treatment response to buprenorphine plus medical counseling (BUP+MC) for opioid use disorder (OUD).
To describe patterns of reduction in illicit opioid use of patients both labeled as a success and nonsuccess based on an abstinent-based treatment outcome rule.
DESIGN, SETTING, AND PARTICIPANTS: This study is a secondary data analysis of 4 harmonized randomized clinical trials on BUP+MC for OUD from multiple sites that included 869 patients with OUD. These data were analyzed on April 23, 2024. By week 12, 643 participants of the sample original remained (74%).
All studies included patients randomized to BUP+MC or BUP plus enhanced MC (eg, delivered with adjunctive cognitive behavioral therapy).
Weekly self-reported days of illicit opioid use through 12 weeks of treatment. Abstinence was confirmed by urine drug screen.
This study included 869 adults with OUD aged 18 to 69 (mean, 34.2 [SD, 10.45]) years; 287 patients were female (33%), 52 identified as Black (6%), 70 identified Hispanic (8%), 713 identified as White (82%), and 34 identified as other racial groups (4%). Only 377 patients (43%) would have been labeled a success using an abstinence-based success rule. However, the total sample reported a decrease from a mean baseline rate of illicit opioid use nearly every day (6.21 [SD, 1.50] days per week) to a mean of less than 1 day per week at week 12 (0.54 [SD, 1.28]). Importantly, even those who were labeled as nonsuccessful reported a substantial reduction in opioid use from a mean of 6.29 (SD, 1.42) days per week to 1.51 (SD, 1.76) days per week.
In this study, about half of patients receiving BUP+MC achieved near complete abstinence; however, many more experienced a partial treatment response characterized by a substantial reduction in illicit opioid use that falls short of abstinence. Future studies are needed to characterize how these reductions are associated with functional and long-term outcomes. Dissemination of BUP+MC as part of standard buprenorphine prescribing practices is an essential next step given the robust average response of this intervention.
依赖基于禁欲的治疗成功规则可能无法全面反映丁丙诺啡加药物咨询（BUP+MC）治疗阿片类物质使用障碍（OUD）的治疗反应连续体。
描述根据基于禁欲的治疗结果规则被标记为成功和不成功的患者非法阿片类物质使用减少的模式。
设计、设置和参与者：本研究是对4项关于BUP+MC治疗OUD的多中心协调随机临床试验的二次数据分析，共纳入869例OUD患者。这些数据于2024年4月23日进行分析。到第12周时，样本中的643名参与者仍在研究中（74%）。
所有研究均纳入随机接受BUP+MC或BUP加强化MC（如辅以认知行为疗法）的患者。
治疗12周内每周自我报告的非法阿片类物质使用天数。通过尿液药物筛查确认禁欲情况。
本研究纳入了869名年龄在18至69岁（平均34.2[标准差，10.45]岁）的OUD成年患者；287例为女性（33%），52例为黑人（6%），70例为西班牙裔（8%），713例为白人（82%），34例为其他种族群体（4%）。使用基于禁欲的成功规则，只有377例患者（43%）会被标记为成功。然而，整个样本报告非法阿片类物质使用的平均基线率从几乎每天（每周6.21[标准差，1.50]天）下降到第12周时每周不到1天（0.54[标准差，1.28]）。重要的是，即使是那些被标记为不成功的患者，其阿片类物质使用也从平均每周6.29（标准差，1.42）天大幅减少到1.51（标准差，1.76）天。
在本研究中，接受BUP+MC治疗的患者中约一半实现了近乎完全禁欲；然而，更多患者经历了部分治疗反应，其特征是非法阿片类物质使用大幅减少但未达到禁欲状态。未来需要开展研究来描述这些减少与功能和长期结局之间的关联。鉴于该干预措施的强劲平均反应，将BUP+MC作为标准丁丙诺啡处方实践的一部分进行推广是至关重要的下一步。
