Explaining differential effects of medication for opioid use disorder using a novel approach incorporating mediating variables.
Background and Aims: A recent study found that homeless individuals with opioid use disorder (OUD) had a lower risk of relapse on extended‐release naltrexone (XR‐NTX) versus buprenorphine–naloxone (BUP‐NX), whereas non‐homeless individuals had a lower risk of relapse on BUP‐NX. This secondary study...
| Publicado en: | Addiction Vol. 116; no. 8; pp. 2094 - 2104 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=151210158&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 151210158 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09652140 AIO jtl: Addiction issn: 09652140 maglogo: Y pubinfo: dt: Aug2021 vid: 116 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 151210158 148223815 151210158 151210158 10.1111/add.15377 151210158 ppf: 2094 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Explaining differential effects of medication for opioid use disorder using a novel approach incorporating mediating variables. aug: au: Rudolph, Kara E. Díaz, Iván Hejazi, Nima S. Laan, Mark J. Luo, Sean X. Shulman, Matisyahu Campbell, Aimee Rotrosen, John Nunes, Edward V. affil: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York NY,, USA sug: subj: Substance Use Disorders Drug Therapy Homelessness Psychosocial Factors Naltrexone Administration and Dosage Buprenorphine Administration and Dosage Naloxone Administration and Dosage Drug Therapy, Combination Recurrence Risk Factors Risk Assessment Human Secondary Analysis Communities United States Adult DSM Inpatients Patient Admission Descriptive Statistics Mediation Analysis Patient Compliance Depression Pain Confidence Intervals Treatment Outcomes Adult: 19-44 years ab: Background and Aims: A recent study found that homeless individuals with opioid use disorder (OUD) had a lower risk of relapse on extended‐release naltrexone (XR‐NTX) versus buprenorphine–naloxone (BUP‐NX), whereas non‐homeless individuals had a lower risk of relapse on BUP‐NX. This secondary study examined differences in mediation pathways to medication effect between homeless and non‐homeless participants. Design Secondary analysis of an open‐label randomized controlled, 24‐week comparative effectiveness trial, 2014–17. Setting: Eight community addiction treatment programs in the United States. Participants: English‐speaking adults with DSM‐5 OUD, recruited during inpatient admission (n = 570). Intervention(s): Randomization to monthly injection of XR‐NTX or daily sublingual BUP‐NX. Measurements(s): Mediation analysis estimated the direct effect of XR‐NTX versus BUP‐NX on relapse and indirect effect through mediators of medication adherence, use of illicit opioids, depressive symptoms and pain, separately by homeless status. Findings For the homeless subgroup, the protective indirect path contributed a 3.4 percentage point reduced risk of relapse [95% confidence interval (CI) = −12.0, 5.3] comparing XR‐NTX to BUP‐NX (explaining 21% of the total effect). For the non‐homeless subgroup, the indirect path contributed a 9.4 percentage point increased risk of relapse (95% CI = 3.1, 15.7) comparing XR‐NTX to BUP‐NX (explaining 57% of the total effect). Conclusions: A novel approach to mediation analysis shows that much of the difference in medication effectiveness (extended‐release naltrexone versus buprenorphine–naloxone) on opioid relapse among non‐homeless adults with opioid use disorder appears to be explained by mediators of adherence, illicit opioid use, depressive symptoms and pain. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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