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Long‐term follow‐up assessment of opioid use outcomes among individuals with comorbid mental disorders and opioid use disorder treated with buprenorphine or methadone in a randomized clinical trial
Author(s) -
Hser YihIng,
Zhu Yuhui,
Fei Zhe,
Mooney Larissa J.,
Evans Elizabeth A.,
Kelleghan Annemarie,
Matthews Abigail,
Yoo Caroline,
Saxon Andrew J.
Publication year - 2022
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.15594
Subject(s) - opioid use disorder , buprenorphine , medicine , randomized controlled trial , methadone , mood , odds ratio , confidence interval , psychiatry , opioid , bipolar disorder , mood disorders , anxiety , receptor
Abstract Aims To investigate whether reduction in opioid use differs when treated by either buprenorphine–naloxone (BUP) or methadone (MET) among adults with comorbid opioid use disorder (OUD) and mental disorders. Design, Setting and Participants In a randomized controlled trial, adults with OUD were randomized to 24 weeks of either BUP or MET treatment and were followed up in 3‐yearly assessments. The present secondary analyses were based on 597 participants who completed all assessments. Measurements The outcome measure was the number of days of using opioids per month during the follow‐up period. The Mini‐International Neuropsychiatric Interview (MINI) was used to classify participants into three groups: life‐time mood disorder ( n = 302), life‐time mental disorder other than mood disorder ( n = 114) and no mental disorder ( n = 181). Medication treatment (BUP, MET, no treatment) during the follow‐up period was a time‐varying predictor. Findings Based on zero‐inflated Poisson (ZIP) mixed regression analysis, it was found that relative to no treatment, opioid use during the follow‐up was significantly reduced by BUP [odds ratio (OR) = 0.12, 95% confidence interval (CI) = 0.07–0.21 for any use; risk ratio (RR) = 0.77, 95% CI =0.66–0.89 for days of use] and by MET [OR = 0.33, 95% CI = 0.25–0.45 for any use; RR = 0.78, 95% CI = 0.72–0.84 for days of use]. Relative to MET, BUP was associated with a lower likelihood of any opioid use among participants with mood disorders (OR = 0.52, 95% CI = 0.36–0.74) and for participants without mental disorder (OR = 0.37, 95% CI = 0.21–0.66) and fewer number of days using opioids (RR = 0.37, 95% CI = 0.25–0.56) among participants with other mental disorders. Conclusions Among adults with comorbid opioid use disorder and mental disorders, treatment with buprenorphine–naloxone produced greater reductions in opioid use than treatment with methadone.