人们对阿片类药物激动剂治疗(OAT)和芬太尼使用之间的关系知之甚少,具体而言。本研究旨在估计当前使用不同形式的OAT之间的关联,包括美沙酮,丁丙诺啡/纳洛酮(BUP/NX),缓释口服吗啡(SROM),或可注射阿片类激动剂治疗(iOAT),以及与没有OAT相比,芬太尼阳性尿液药物测试(UDT)的可能性。
数据来自温哥华三个社区招募的使用毒品的人的前瞻性队列研究,加拿大从2016年12月到2018年11月。使用多变量广义估计方程(GEE),我们检查了当前使用每种形式的OAT之间的关联,与没有OAT相比,和芬太尼阳性UDT在使用阿片类药物的参与者中。
915名参与者在两次随访中贡献了2112个UDT。大多数UDT(74.9%)对芬太尼呈阳性。在对先验定义的混杂因素进行调整后,与没有OAT相比,当前使用BUP/NX与芬太尼阳性UDT的几率较低相关(优势比[OR]=0.36,95%置信区间[CI]:0.22-0.58),而当前使用美沙酮(OR=0.84,95%CI:0.65-1.07),iOAT(OR=1.30,95%CI:0.75-2.28),和SROM(OR=1.34,95%CI:0.74-2.43)均未出现。
在温哥华使用阿片类药物的人群中,仅使用BUP/NX与芬太尼阳性UDT的几率较低相关.我们的发现强调了尽管使用了OAT,但仍在继续使用芬太尼的比率很高,并支持将BUP/NX用于治疗使用芬太尼的人。
Little is known about the relationship between opioid agonist therapy (OAT) and fentanyl use, specifically. This study aimed to estimate the association between current use of different forms of OAT, including methadone, buprenorphine/naloxone (BUP/NX), slow release oral morphine (SROM), or injectable opioid agonist treatment (iOAT), and the likelihood of a fentanyl-positive urine drug test (UDT) as compared to no OAT.
Data were obtained from three community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada from December 2016 through November 2018. Using multivariable Generalized Estimating Equations (GEE), we examined the association between current use of each form of OAT, as compared to no OAT, and fentanyl-positive UDT among participants who use opioids.
The 915 participants contributed 2112 UDTs over a median of two follow-up visits. The majority of UDTs (74.9 %) were positive for fentanyl. After adjustment for a priori defined confounding factors, compared to no OAT, current use of BUP/NX was associated with lower odds of fentanyl-positive UDT (odds ratio [OR] = 0.36, 95 % confidence interval [CI]: 0.22-0.58) while current use of methadone (OR = 0.84, 95 % CI: 0.65-1.07), iOAT (OR = 1.30, 95 % CI: 0.75-2.28), and SROM (OR = 1.34, 95 % CI: 0.74-2.43) were not.
In this cohort of people who use opioids in Vancouver, only use of BUP/NX was associated with lower odds of fentanyl-positive UDT. Our findings highlight high rates of ongoing fentanyl use despite the use of OAT and support the expansion of BUP/NX for the treatment of people who use fentanyl.