Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations

Addiction Science & Clinical Practice

Research

K. Humphreys¹  O. A. Arah²  K. E. Rudolph³  J. I. Tsui⁴  S. X. Luo⁵  X. A. Levander⁶  R. R. Cook⁶  C. Foot⁶  P. T. Korthuis⁶ 

[1] Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA;Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA;Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA;Division of Physical Sciences, Department of Statistics, UCLA College, Los Angeles, CA, USA;Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark;Department of Epidemiology, School of Public Health, Columbia University, New York, NY, USA;Department of Medicine, University of Washington, Seattle, WA, USA;Division on Substance Use Disorders, Department of Psychiatry, Columbia University, New York, USA;Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, 97239, Portland, OR, USA;

关键词: Stimulants;    Methamphetamine;    Cocaine;    Medications for opioid use disorder;    Buprenorphine;    Extended-release naltrexone;    Transportability;    Generalizability;   

DOI  :  10.1186/s13722-023-00364-3

 received in 2022-08-29, accepted in 2023-02-01,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCo-use of stimulants and opioids is rapidly increasing. Randomized clinical trials (RCTs) have established the efficacy of medications for opioid use disorder (MOUD), but stimulant use may decrease the likelihood of initiating MOUD treatment. Furthermore, trial participants may not represent “real-world” populations who would benefit from treatment.MethodsWe conducted a two-stage analysis. First, associations between stimulant use (time-varying urine drug screens for cocaine, methamphetamine, or amphetamines) and initiation of buprenorphine or extended-release naltrexone (XR-NTX) were estimated across two RCTs (CTN-0051 X:BOT and CTN-0067 CHOICES) using adjusted Cox regression models. Second, results were generalized to three target populations who would benefit from MOUD: Housed adults identifying the need for OUD treatment, as characterized by the National Survey on Drug Use and Health (NSDUH); adults entering OUD treatment, as characterized by Treatment Episodes Dataset (TEDS); and adults living in rural regions of the U.S. with high rates of injection drug use, as characterized by the Rural Opioids Initiative (ROI). Generalizability analyses adjusted for differences in demographic characteristics, substance use, housing status, and depression between RCT and target populations using inverse probability of selection weighting.ResultsAnalyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The majority were aged 30–49 years, male, and non-Hispanic White. In RCTs, stimulant use reduced the likelihood of MOUD initiation by 32% (adjusted HR [aHR] = 0.68, 95% CI 0.49–0.94, p = 0.019). Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment (25% reduction, aHR = 0.75, 0.48–1.18, p = 0.215) and adults entering OUD treatment (28% reduction, aHR = 0.72, 0.51–1.01, p = 0.061). The association was more pronounced, but still non-significant among rural people injecting drugs (39% reduction, aHR = 0.61, 0.35–1.06, p = 0.081). Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population (76% reduction, aHR = 0.24, 0.08–0.69, p = 0.008).ConclusionsStimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, especially among rural people injecting drugs, who already suffer from limited access to MOUD.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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