PMID- 35712892
OWN - NLM
STAT- MEDLINE
DCOM- 20220908
LR  - 20231002
IS  - 1360-0443 (Electronic)
IS  - 0965-2140 (Print)
IS  - 0965-2140 (Linking)
VI  - 117
IP  - 10
DP  - 2022 Oct
TI  - Impact of fentanyl use on initiation and discontinuation of methadone and 
      buprenorphine/naloxone among people with prescription-type opioid use disorder: 
      secondary analysis of a Canadian treatment trial.
PG  - 2662-2672
LID - 10.1111/add.15954 [doi]
AB  - BACKGROUND AND AIMS: Fentanyl is primarily responsible for the current phase of 
      the overdose epidemic in North America. Despite the benefits of treatment with 
      medications for opioid use disorder (MOUD), there are limited data on the 
      association between fentanyl, MOUD type and treatment engagement. The objectives 
      of this analysis were to measure the impact of baseline fentanyl exposure on 
      initiation and discontinuation of MOUD among individuals with prescription-type 
      opioid use disorder (POUD). DESIGN, SETTING AND PARTICIPANTS: Secondary analysis 
      of a Canadian multi-site randomized pragmatic trial conducted between 2017 and 
      2020. Of the 269 randomized participants, 65.4% were male, 67.3% self-identified 
      as white and 55.4% had a positive fentanyl urine drug test (UDT) at baseline. 
      Fentanyl-exposed participants were more likely to be younger, to self-identify as 
      non-white, to be unemployed or homeless and to be currently using stimulants than 
      non-fentanyl-exposed participants. INTERVENTIONS: Flexible take-home dosing 
      buprenorphine/naloxone or supervised methadone models of care for 24 weeks. 
      MEASUREMENTS: Outcomes were (1) MOUD initiation and (2) time to (a) assigned and 
      (b) overall MOUD discontinuation. Independent variables were baseline fentanyl 
      UDT (predictor) and assigned MOUD (effect modifier). FINDINGS: Overall, 209 
      participants (77.7%) initiated MOUD. In unadjusted analyses, fentanyl exposure 
      was associated with reduced likelihood of treatment initiation [odds ratio 
      (OR) = 0.18, 95% confidence interval (CI) = 0.08-0.36] and shorter median times 
      in assigned [20 versus 168 days, hazard ratio (HR) = 3.61, 95% CI = 2.52-5.17] 
      and any MOUD (27 versus 168 days, HR = 3.32, 95% CI = 2.30-4.80). The negative 
      effects were no longer statistically significant in adjusted models, and no 
      interaction between fentanyl and MOUD was observed for any of the outcomes (all 
      P > 0.05). CONCLUSIONS: Both buprenorphine/naloxone and methadone may be 
      appropriate treatment options for people with prescription-type opioid use 
      disorder regardless of fentanyl exposure. Other characteristics of 
      fentanyl-exposed individuals appear to be driving the association with poorer 
      treatment outcomes.
CI  - (c) 2022 Society for the Study of Addiction.
FAU - Socias, M Eugenia
AU  - Socias ME
AUID- ORCID: 0000-0003-2556-7049
AD  - British Columbia Centre on Substance Use, Vancouver, BC, Canada.
AD  - Department of Medicine, Faculty of Medicine, University of British Columbia, 
      Vancouver, BC, Canada.
FAU - Wood, Evan
AU  - Wood E
AD  - British Columbia Centre on Substance Use, Vancouver, BC, Canada.
AD  - Department of Medicine, Faculty of Medicine, University of British Columbia, 
      Vancouver, BC, Canada.
FAU - Le Foll, Bernard
AU  - Le Foll B
AD  - Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences 
      Building, University of Toronto, Toronto, ON, Canada.
AD  - Department of Family and Community Medicine, Faculty of Medicine, University of 
      Toronto, Toronto, ON, Canada.
AD  - Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
AD  - Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
AD  - Campbell Family Mental Health Research Institute, Center for Addiction and Mental 
      Health (CAMH), Toronto, ON, Canada.
AD  - Acute Care Programme, CAMH, Toronto, ON, Canada.
FAU - Lim, Ron
AU  - Lim R
AD  - Department of Family Medicine and Psychiatry, Cumming School of Medicine, 
      University of Calgary, Calgary, AB, Canada.
FAU - Choi, Jin Cheol
AU  - Choi JC
AD  - British Columbia Centre on Substance Use, Vancouver, BC, Canada.
FAU - Mok, Wing Yin
AU  - Mok WY
AD  - British Columbia Centre on Substance Use, Vancouver, BC, Canada.
FAU - Bruneau, Julie
AU  - Bruneau J
AUID- ORCID: 0000-0002-3484-6456
AD  - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), 
      Montreal, QC, Canada.
AD  - Department of Family and Emergency Medicine, Faculty of Medicine, Universite de 
      Montreal, Montreal, QC, Canada.
FAU - Rehm, Jurgen
AU  - Rehm J
AUID- ORCID: 0000-0001-5665-0385
AD  - Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
AD  - Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
AD  - Institute for Mental Health Policy Research, CAMH, Toronto, ON, Canada.
AD  - Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical 
      Epidemiology and Longitudinal Studies, Technische Universitat Dresden, Dresden, 
      Germany.
AD  - Department of International Health Projects, Institute for Leadership and Health 
      Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
FAU - Wild, T Cameron
AU  - Wild TC
AUID- ORCID: 0000-0002-9947-7428
AD  - School of Public Health, University of Alberta, Edmonton, AB, Canada.
FAU - Bozinoff, Nikki
AU  - Bozinoff N
AD  - Department of Family and Community Medicine, Faculty of Medicine, University of 
      Toronto, Toronto, ON, Canada.
AD  - Campbell Family Mental Health Research Institute, Center for Addiction and Mental 
      Health (CAMH), Toronto, ON, Canada.
FAU - Hassan, Ahmed
AU  - Hassan A
AUID- ORCID: 0000-0003-0115-1858
AD  - Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences 
      Building, University of Toronto, Toronto, ON, Canada.
AD  - Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
AD  - Campbell Family Mental Health Research Institute, Center for Addiction and Mental 
      Health (CAMH), Toronto, ON, Canada.
FAU - Jutras-Aswad, Didier
AU  - Jutras-Aswad D
AUID- ORCID: 0000-0002-8474-508X
AD  - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), 
      Montreal, QC, Canada.
AD  - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de 
      Montreal, Montreal, QC, Canada.
CN  - OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse
LA  - eng
GR  - R25 DA037756/DA/NIDA NIH HHS/United States
GR  - CIHR/Canada
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20220617
PL  - England
TA  - Addiction
JT  - Addiction (Abingdon, England)
JID - 9304118
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Buprenorphine, Naloxone Drug Combination)
RN  - 40D3SCR4GZ (Buprenorphine)
RN  - UC6VBE7V1Z (Methadone)
RN  - UF599785JZ (Fentanyl)
SB  - IM
MH  - Analgesics, Opioid/therapeutic use
MH  - *Buprenorphine/therapeutic use
MH  - Buprenorphine, Naloxone Drug Combination/therapeutic use
MH  - Canada/epidemiology
MH  - Female
MH  - Fentanyl/therapeutic use
MH  - Humans
MH  - Male
MH  - Methadone/therapeutic use
MH  - Opiate Substitution Treatment
MH  - *Opioid-Related Disorders/epidemiology
MH  - Prescriptions
PMC - PMC9969999
MID - NIHMS1877523
OTO - NOTNLM
OT  - Buprenorphine
OT  - clinical trial
OT  - fentanyl
OT  - methadone
OT  - opioid use disorder
OT  - prescription opioids
EDAT- 2022/06/18 06:00
MHDA- 2022/09/09 06:00
PMCR- 2023/10/01
CRDT- 2022/06/17 03:43
PHST- 2021/12/17 00:00 [received]
PHST- 2022/05/03 00:00 [accepted]
PHST- 2022/06/18 06:00 [pubmed]
PHST- 2022/09/09 06:00 [medline]
PHST- 2022/06/17 03:43 [entrez]
PHST- 2023/10/01 00:00 [pmc-release]
AID - 10.1111/add.15954 [doi]
PST - ppublish
SO  - Addiction. 2022 Oct;117(10):2662-2672. doi: 10.1111/add.15954. Epub 2022 Jun 17.