Background: Extended-release naltrexone (XR-NTX) is effective for illicit opioid abstinence as an opioid maintenance treatment. To improve treatment outcomes, patient’s preference for the modality of treatment is an important factor. Objectives: We aimed to test the relationship between baseline preference for XR-NTX and adherence to treatment, use of illicit opioids, and risk of relapse. Methods: In an open-label, Norwegian clinical trial participants with opioid use disorder were randomized to either monthly injections with XR-NTX or daily sublingual buprenorphine-naloxone (BP-NLX) for 12 weeks. Subsequently, participants could continue with their preferred medication in a 36-week follow-up and in a prolonged period of 104 weeks. Results: Of 153 participants who completed detoxification, 72% were men, with a mean age of 36 years. Preference levels were similar across the randomized groups, with no significant associations between preference and adherence to treatment, opioid use, or relapse. The BP-NLX group had a significantly higher risk of first relapse to opioids than the XR-NTX group for all levels of preference (p #x3c; 0.001) and a significantly higher number of days of illicit opioid use. In the follow-up period, the adherence rate was twice as high among participants with the highest preference compared to participants with the lowest preference, both among those who switched to XR-NTX and those who continued (hazard ratio 2.2; 1.2–4.0, p = 0.013). Opioid use was significantly higher among participants who switched to XR-NTX with the lowest preference than the medium (p = 0.003) or the highest (p = 0.001) preference. The risk of relapse to opioids, however, was significantly higher among XR-NTX continuing participants with the lowest (p = 0.002) or the medium (p = 0.043) preference than those with the highest preference. Conclusions: Individuals who matched with their preferred treatment used less illicit opioids than those who did not during short-term treatment. However, baseline preference for XR-NTX treatment primarily influenced longer term opioid use and treatment adherence.
Eur Addict Res

中文翻译：

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缓释纳曲酮对治疗依从性、阿片类药物使用和复发的偏好程度的预测价值

背景：缓释纳曲酮 (XR-NTX) 作为阿片类药物维持治疗对非法阿片类药物戒断有效。为了改善治疗结果，患者对治疗方式的偏好是一个重要因素。目的：我们旨在测试 XR-NTX 的基线偏好与治疗依从性、非法阿片类药物的使用和复发风险之间的关系。方法：在一项开放标签中，患有阿片类药物使用障碍的挪威临床试验参与者被随机分配到每月注射 XR-NTX 或每日舌下含服丁丙诺啡-纳洛酮 (BP-NLX) 12 周。随后，参与者可以在 36 周的随访和 104 周的长期随访中继续使用他们首选的药物。结果：在完成排毒的 153 名参与者中，72% 为男性，平均年龄为 36 岁。随机组的偏好水平相似，偏好与治疗依从性、阿片类药物使用或复发之间没有显着关联。与 XR-NTX 组相比，BP-NLX 组首次复发阿片类药物的风险显着高于 XR-NTX 组（p #x3c；0.001），并且非法阿片类药物使用天数显着增加。在随访期间，与偏好最低的参与者相比，偏好最高的参与者的依从率是切换到 XR-NTX 和继续使用的参与者的两倍（风险比 2.2；1.2-4.0，p= 0.013)。在偏好最低的 XR-NTX 的参与者中，阿片类药物的使用显着高于中等 ( p = 0.003) 或最高 ( p = 0.001) 偏好的参与者。然而，与偏好最高的参与者相比，偏好最低 ( p = 0.002) 或中等 ( p = 0.043) 的XR-NTX 持续参与者的阿片类药物复发风险显着更高。结论：与首选治疗相匹配的个体在短期治疗期间使用的非法阿片类药物较少。然而，对 XR-NTX 治疗的基线偏好主要影响长期阿片类药物的使用和治疗依从性。
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