Lim Jihoon, Bruneau Julie, Platt Robert W, Panagiotoglou Dimitra
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 2001 McGill College Avenue, Suite 1200, Montréal, QC, H3A 1G1, Canada.
Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
Drug Saf. 2025 Jul 3. doi: 10.1007/s40264-025-01574-1.
Opioid agonist treatment (OAT) reduces drug-related poisonings and injection-related infections among people with opioid use disorder (OUD). Despite buprenorphine-naloxone (BNX) and methadone (MET) both being first-line OAT options in Canada, their comparative effectiveness in preventing recurrent injection-related infections and poisonings remains unclear.
This study compared the effectiveness of buprenorphine-naloxone and methadone in reducing recurrent risks of injection-related bacterial infections and opioid-related poisoning among people on OAT.
We used administrative health data from Québec, Canada to create our cohort of adult patients (aged 18-65 years) on OAT maintenance between 2014 and 2019. We applied a time-dependent Cox proportional hazards model for our time-varying exposure definition to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the recurrent risks of injection-related bacterial infections and opioid-related poisoning, adjusting for age, sex, socio-demographic, and clinical factors. We also compared the effectiveness of buprenorphine-naloxone and methadone during the OAT induction phase (i.e., first 30 days of treatment).
The study population included 2010 patients (mean age: 41.21 years, 67.41% male). Compared to methadone, buprenorphine-naloxone was associated with 45% lower recurrent risk of opioid-related poisoning (HR: 0.55; 95% CI 0.35-0.86). Overall, the association between buprenorphine-naloxone and recurrent risk of injection-related bacterial infections suggested a weak protective effect (HR: 0.80; 95% CI 0.59-1.09). During the induction phase, there was limited evidence of differences between buprenorphine-naloxone and methadone for the recurrent risks of injection-related bacterial infections (HR: 0.91; 95% CI 0.51-1.60) and opioid-related poisoning (HR: 1.07; 95% CI 0.51-2.24).
Among patients in OAT maintenance, buprenorphine-naloxone was associated with lower risk of recurrent opioid-related poisoning compared to methadone, but not for injection-related infections. This advantage was not observed during induction, suggesting the need for improved treatment retention early in OAT.
阿片类激动剂治疗（OAT）可降低阿片类物质使用障碍（OUD）患者中与药物相关的中毒及注射相关感染的发生率。尽管丁丙诺啡-纳洛酮（BNX）和美沙酮（MET）在加拿大均为一线OAT治疗选择，但其在预防复发性注射相关感染和中毒方面的相对有效性仍不明确。
本研究比较了丁丙诺啡-纳洛酮和美沙酮在降低接受OAT治疗患者复发性注射相关细菌感染及阿片类物质相关中毒风险方面的有效性。
我们使用了加拿大魁北克省的行政卫生数据，建立了2014年至2019年间接受OAT维持治疗的成年患者（年龄18 - 65岁）队列。我们对随时间变化的暴露定义应用了时间依赖性Cox比例风险模型，以估计注射相关细菌感染和阿片类物质相关中毒复发性风险的风险比（HR）和95%置信区间（CI），并对年龄、性别、社会人口统计学和临床因素进行了调整。我们还比较了丁丙诺啡-纳洛酮和美沙酮在OAT诱导期（即治疗的前30天）的有效性。
研究人群包括2010名患者（平均年龄：41.21岁，67.41%为男性）。与美沙酮相比，丁丙诺啡-纳洛酮使阿片类物质相关中毒的复发风险降低了45%（HR：0.55；95% CI 0.35 - 0.86）。总体而言，丁丙诺啡-纳洛酮与注射相关细菌感染复发风险之间的关联显示出较弱的保护作用（HR：0.80；95% CI 0.59 - 1.09）。在诱导期，丁丙诺啡-纳洛酮和美沙酮在注射相关细菌感染复发风险（HR：0.91；95% CI 0.51 - 1.60）和阿片类物质相关中毒复发风险（HR：1.07；95% CI 0.51 - 2.24）方面差异的证据有限。
在接受OAT维持治疗的患者中，与美沙酮相比，丁丙诺啡-纳洛酮与较低的阿片类物质相关中毒复发风险相关，但与注射相关感染无关。在诱导期未观察到这一优势，这表明在OAT早期需要改善治疗依从性。
