Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials

International Journal of Environmental Research and Public Health

Seshadri C. Mudumbai¹  Carolyn M. Ervin²  James W. Baurley²  Andrew J. Saxon³  Randall S. Stafford⁴  Andrew W. Bergen⁵  Christopher S. McMahan⁶  Joe Bible⁶ 

[1] Anesthesia Service, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA;BioRealm, LLC, Walnut, CA 91789, USA;Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA 98108, USA;Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA;Oregon Research Institute, Eugene, OR 97403, USA;School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC 29634, USA;

关键词: opioid-related disorders;    buprenorphine;    meta-analysis;    opiate substitution treatment;    urinalysis;   

DOI  :  10.3390/ijerph19074106

来源: DOAJ

【 摘 要 】

The impact of agonist dose and of physician, staff and patient engagement on treatment have not been evaluated together in an analysis of treatment for opioid use disorder. Our hypotheses were that greater agonist dose and therapeutic engagement would be associated with reduced illicit opiate use in a time-dependent manner. Publicly-available treatment data from six buprenorphine efficacy and safety trials from the Federally-supported Clinical Trials Network were used to derive treatment variables. Three novel predictors were constructed to capture the time weighted effects of buprenorphine dosage (mg buprenorphine per day), dosing protocol (whether physician could adjust dose), and clinic visits (whether patient attended clinic). We used time-in-trial as a predictor to account for the therapeutic benefits of treatment persistence. The outcome was illicit opiate use defined by self-report or urinalysis. Trial participants (N = 3022 patients with opioid dependence, mean age 36 years, 33% female, 14% Black, 16% Hispanic) were analyzed using a generalized linear mixed model. Treatment variables dose, Odds Ratio (OR) = 0.63 (95% Confidence Interval (95%CI) 0.59–0.67), dosing protocol, OR = 0.70 (95%CI 0.65–0.76), time-in-trial, OR = 0.75 (95%CI 0.71–0.80) and clinic visits, OR = 0.81 (95%CI 0.76–0.87) were significant (p-values < 0.001) protective factors. Treatment implications support higher doses of buprenorphine and greater engagement of patients with providers and clinic staff.

【 授权许可】

Unknown