目的:美沙酮药物治疗阿片类药物使用障碍(M-MOUD)的患者通常有复杂的阿片类药物使用史,经常与其他药物联合使用。尚不清楚M-MOUD患者持续使用物质或多物质的频率。我们测量了大量非法药物使用的趋势,M-MOUD患者的多州人群和治疗第一年持续使用药物。
方法:2017年至2021年美国(US)M-MOUD患者的回顾性队列研究,重点是提供给MillenniumHealth测试的尿液药物标本,第三方实验室使用液相色谱-串联质谱法(LC-MS/MS)分析样品。使用广义估计方程(GEE)来估计治疗期间阳性的平均趋势。
方法:样本是从美国10个州的诊所获得的,这些诊所在研究期间提供了至少300名独特的患者(阿拉斯加,亚利桑那,佛罗里达,伊利诺伊州,肯塔基,明尼苏达,新墨西哥州,俄亥俄州,弗吉尼亚和华盛顿)。
方法:接受M-MOUD的阿片类药物使用障碍患者(n=16386)。
方法:海洛因的阳性率,芬太尼,甲基苯丙胺和可卡因.
结果:从2017年到2021年,芬太尼首次采集标本的年粗阳性率增加(13.1%-53.0%,P<0.001),甲基苯丙胺(10.6%-27.2%,P<0.001)和可卡因(13.8%-19.5%,P<0.001);对于海洛因阳性没有显著变化(6.9%-6.5%,P=0.74)。在估计第1周到第52周患者轨迹的回归模型中,芬太尼的边际阳性从21.8%下降到17.1%(发生率比[IRR]=0.78,P<0.001),海洛因阳性从8.4%下降到4.3%(IRR=0.51,P<0.001),但是甲基苯丙胺和可卡因的阳性没有显著变化,平均为17.7%(IRR=0.98,P=0.53)和9.2%(IRR=0.96,P=0.36),分别。
结论:在2017年至2021年之间,接受阿片类药物治疗的美国患者芬太尼检测呈阳性,甲基苯丙胺和可卡因.美沙酮药物治疗阿片类药物使用障碍似乎仍然是减少非法阿片类药物使用的有效干预措施。
Patients in methadone medication treatment for opioid use disorder (M-MOUD) typically have a complex history of opioid use, often in combination with other drugs. It is unknown how frequently M-MOUD patients experience persistent substance or polysubstance use. We measured trends in illicit substance use in a large, multistate population of M-MOUD patients and persistence of substance use in the first year of treatment.
Retrospective cohort study of United States (US) M-MOUD patients from 2017 to 2021, focused on urine drug specimens provided for testing to Millennium Health, a third-party laboratory. Specimens were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Generalized estimating equations (GEE) were used to estimate the average trends in positivity during time in treatment.
Specimens were obtained from clinics in 10 US states that provided at least 300 unique patients during the study period (Alaska, Arizona, Florida, Illinois, Kentucky, Minnesota, New Mexico, Ohio, Virginia and Washington).
Patients with opioid use disorder receiving M-MOUD (n = 16 386).
Positivity rates for heroin, fentanyl, methamphetamine and cocaine.
From 2017 to 2021, yearly crude positivity rates for first collected specimens increased for fentanyl (13.1%-53.0%, P < 0.001), methamphetamine (10.6%-27.2%, P < 0.001) and cocaine (13.8%-19.5%, P < 0.001); for heroin positivity did not significantly change (6.9%-6.5%, P = 0.74). In regression models estimating patient trajectories from week 1 to week 52, marginal fentanyl positivity declined from 21.8% to 17.1% (incidence rate ratio [IRR] = 0.78, P < 0.001) and heroin positivity declined from 8.4% to 4.3% (IRR = 0.51, P < 0.001), but positivity for methamphetamine and cocaine did not significantly change, remaining at an average of 17.7% (IRR = 0.98, P = 0.53) and 9.2% (IRR = 0.96, P = 0.36), respectively.
Between 2017 and 2021, United States patients presenting to opioid treatment programs increasingly tested positive for fentanyl, methamphetamine and cocaine. Methadone medication treatment for opioid use disorder appears to remain an effective intervention for reducing illicit opioid use.