Abstract

Objectives

Our objectives were to examine the impact of methamphetamine use on opioid use disorder (OUD) treatment retention in patients prescribed either buprenorphine/buprenorphine-naloxone (BUP-NX) or naltrexone/extended-release naltrexone (XR-NTX), while also exploring the role of other risk factors that may modify the impact of methamphetamine use.

Methods

We conducted an exploratory retrospective study examining OUD treatment retention in 127 patients in Ohio (USA). Patients were prescribed either BUP-NX or naltrexone/XR-NTX. Cox proportional hazard regression was used to compare time to dropout of treatment between patients positive and negative on screening for methamphetamines at intake, estimate the association between other risk factors and time to dropout, and test interactions between risk factors and methamphetamine status.

Results

Among patients prescribed naltrexone/XR-NTX, those positive for methamphetamines had almost three times the risk of treatment dropout (AHR = 2.89, 95% CI =1.11, 7.07), significantly greater (interaction p = .039) than the methamphetamine effect among those prescribed BUP-NX (AHR = 0.94, 95% CI = 0.51, 1.65). Early in treatment, being prescribed BUP-NX was strongly associated with a greater risk of treatment dropout (at baseline: AHR = 2.90, 95% CI = 1.33, 7.15), regardless of baseline methamphetamine use status. However, this effect decreased with time and shifted to greater risk of dropout among those prescribed naltrexone/XR-NTX (non-proportional hazard; interaction with time AHR = 0.66, 95% CI = 0.49, 0.86), with the shift occurring sooner among those positive for methamphetamine at baseline.

Conclusions

Additional support should be provided to patients who use methamphetamines prior to starting OUD treatment.

中文翻译：

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探索非医用甲基苯丙胺使用与处方丁丙诺啡或纳曲酮在阿片类药物使用障碍治疗保留中的相互作用

摘要

目标

我们的目标是检查甲基苯丙胺使用对处方丁丙诺啡/丁丙诺啡-纳洛酮 (BUP-NX) 或纳曲酮/缓释纳曲酮 (XR-NTX) 的患者的阿片类药物使用障碍 (OUD) 治疗保留的影响，同时还探索其他可能改变甲基苯丙胺使用影响的风险因素的作用。

方法

我们进行了一项探索性回顾性研究，检查了俄亥俄州（美国）127 名患者的 OUD 治疗保留情况。患者服用 BUP-NX 或纳曲酮/XR-NTX。Cox 比例风险回归用于比较在摄入甲基苯丙胺筛查呈阳性和阴性的患者之间退出治疗的时间，估计其他风险因素与退出时间之间的关联，并测试风险因素与甲基苯丙胺状态之间的相互作用。

结果

在开具纳曲酮/XR-NTX 的患者中，甲基苯丙胺呈阳性的患者退出治疗的风险几乎是其三倍（AHR = 2.89, 95% CI =1.11, 7.07），显着高于（相互作用p = .039）那些规定的 BUP-NX (AHR = 0.94, 95% CI = 0.51, 1.65)。在治疗早期，无论基线甲基苯丙胺的使用状态如何，开具 BUP-NX 处方与治疗退出风险的增加密切相关（基线：AHR = 2.90, 95% CI = 1.33, 7.15）。然而，这种影响随着时间的推移而降低，并在处方纳曲酮/XR-NTX 中转移到更大的辍学风险（非比例风险；与时间的相互作用 AHR = 0.66, 95% CI = 0.49, 0.86），这种转变发生得更快那些在基线时对甲基苯丙胺呈阳性的人。

结论

在开始 OUD 治疗之前，应向使用甲基苯丙胺的患者提供额外的支持。