Young Samantha, Raboud Janet, Dodd Zoë, DeBeck Kora, Milloy M J, Wilson Dean, Hayashi Kanna, Bayoumi Ahmed M, Fairbairn Nadia
British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario M5T 3M6, Canada; Interdepartmental Division of Addiction Medicine, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6.
Dalla Lana School of Public Health, University of Toronto, 155 College Street Room 500, Toronto, Ontario M5T 3M7, Canada.
Drug Alcohol Depend. 2025 Feb 1;267:112547. doi: 10.1016/j.drugalcdep.2024.112547. Epub 2025 Jan 4.
People exposed to fentanyl may report that the dose of methadone in the commonly accepted therapeutic range feels too low. We examined self-reported methadone dose adequacy.
We conducted a retrospective cohort study of individuals prescribed methadone at a dose of at least 60mg daily using data from three community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada from December 2016 through March 2020. We used multivariable generalized estimating equations to estimate the relationship between type of opioid exposure - measured using urine drug tests and categorized as: (1) fentanyl-positive, (2) fentanyl-negative opioid-positive, and (3) fentanyl- and opioid-negative, and report of their methadone dose being too low.
In total, 1732 observations from 616 participants were included, of which 914 (52.8 %) observations had a fentanyl-positive, 178 (10.3 %) had a fentanyl-negative opioid-positive, and 640 (37.0 %) had a fentanyl- and opioid-negative urine drug test. Compared with those with a fentanyl-positive urine drug test, in the adjusted model those with a fentanyl- and opioid-negative urine drug test were significantly less likely to report their methadone dose as too low (adjusted odds ratio [AOR]=0.57, 95 % CI 0.41-0.81), while there was no significant association among those with a fentanyl-negative opioid-positive urine drug test (AOR=0.92, 95 % CI 0.59-1.43).
We found that exposure to non-fentanyl opioids while on methadone was not associated with feeling the dose was too low compared with individuals exposed to fentanyl. Our findings support adequate titration of methadone for individuals with continued exposure to unregulated opioids including fentanyl.
接触芬太尼的人可能会报告，处于公认治疗范围内的美沙酮剂量感觉过低。我们研究了自我报告的美沙酮剂量充足性。
我们利用2016年12月至2020年3月在加拿大温哥华进行的三项社区招募的前瞻性队列研究数据，对每日服用美沙酮剂量至少60毫克的个体进行了一项回顾性队列研究。我们使用多变量广义估计方程来估计阿片类药物接触类型（通过尿液药物检测测量并分类为：(1) 芬太尼阳性，(2) 芬太尼阴性阿片类药物阳性，以及(3) 芬太尼和阿片类药物阴性）与报告美沙酮剂量过低之间的关系。
总共纳入了616名参与者的1732条观察数据，其中914条（52.8%）观察数据的尿液药物检测为芬太尼阳性，178条（10.3%）为芬太尼阴性阿片类药物阳性，640条（37.0%）为芬太尼和阿片类药物阴性尿液药物检测。与尿液药物检测为芬太尼阳性的人相比，在调整模型中，尿液药物检测为芬太尼和阿片类药物阴性的人报告美沙酮剂量过低的可能性显著降低（调整后的优势比[AOR]=0.57，95%置信区间0.41-0.81），而尿液药物检测为芬太尼阴性阿片类药物阳性的人之间没有显著关联（AOR=0.92，95%置信区间0.59-1.43）。
我们发现，与接触芬太尼的个体相比，服用美沙酮时接触非芬太尼阿片类药物与感觉剂量过低无关。我们的研究结果支持对持续接触包括芬太尼在内的不受管制阿片类药物的个体进行美沙酮的适当滴定。
