PMID- 37224674
OWN - NLM
STAT- MEDLINE
DCOM- 20230619
LR  - 20240306
IS  - 1879-0046 (Electronic)
IS  - 0376-8716 (Linking)
VI  - 248
DP  - 2023 Jul 1
TI  - Opioid agonist therapy switching among individuals with prescription-type opioid 
      use disorder: Secondary analysis of a pragmatic randomized trial.
PG  - 109932
LID - S0376-8716(23)00170-9 [pii]
LID - 10.1016/j.drugalcdep.2023.109932 [doi]
AB  - BACKGROUND: Engagement and retention in opioid agonist therapy (OAT) remains a 
      challenge. This study evaluated the impact of initial randomized OAT allocation 
      on subsequent switching among people with prescription-type opioid use disorder 
      (POUD). METHODS: Secondary analysis of a 24-week Canadian multicenter, pragmatic, 
      randomized trial conducted between 2017 and 2020 comparing flexible take-home 
      buprenorphine/naloxone versus supervised methadone models of care for POUD. We 
      used Cox Proportional Hazards modeling to assess for impact of treatment 
      assignment on time to OAT switching, adjusting for important confounders. For 
      clinical correlates, we analyzed data from baseline questionnaires on 
      demographic, substance use, and health factors as well as urine drug screen. 
      RESULTS: Of 272 randomized participants, 210 initiated OAT within 14 days per 
      trial protocol, of whom 103 participants were randomized to 
      buprenorphine/naloxone and 107 to methadone. Within 24-week follow-up, 41 (20.5%) 
      of all participants switched OAT with 25 (24.3%, median 27 days, 88.4 per 100 
      person-years) and 16 participants (15.0%, median 53.5 days, 46.1 per 100 
      person-years) switching from buprenorphine/naloxone and methadone arms, 
      respectively. In adjusted analysis, allocation to buprenorphine/naloxone was 
      associated with significantly higher risk of switching (aHR = 2.31, 95% CI 1.22 - 
      4.38). CONCLUSIONS: OAT switching was common in this sample of individuals with 
      POUD, with individuals randomly allocated to buprenorphine/naloxone being more 
      than twice as likely to switch versus methadone. This may reflect a stepped care 
      approach in OUD management. More research is needed to evaluate overall retention 
      and outcomes with the different observed risks of switching between methadone and 
      buprenorphine/naloxone.
CI  - Copyright (c) 2023 Elsevier B.V. All rights reserved.
FAU - Mocanu, Victor
AU  - Mocanu V
AD  - British Columbia Centre on Substance Use, Vancouver, BC, Canada.
FAU - Bozinoff, Nikki
AU  - Bozinoff N
AD  - Department of Family and Community Medicine, Faculty of Medicine, University of 
      Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, 
      Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
FAU - Wood, Evan
AU  - Wood E
AD  - British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of 
      Medicine, Faculty of Medicine, University of British Columbia, University of 
      British Columbia, Vancouver, BC, Canada.
FAU - Jutras-Aswad, Didier
AU  - Jutras-Aswad D
AD  - Research Centre, Centre Hospitalier de l'Universite de Montreal, 
      Montreal, QC, Canada; Department of Psychiatry and Addictology, Faculty of 
      Medicine, Universite de Montreal, Montreal, QC, Canada.
FAU - Le Foll, Bernard
AU  - Le Foll B
AD  - Department of Family and Community Medicine, Faculty of Medicine, University of 
      Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, 
      Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of 
      Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, 
      University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University 
      of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University 
      of Toronto, Toronto, ON, Canada; Acute Care Program, 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 - Cheol Choi, Jin
AU  - Cheol Choi J
AD  - British Columbia Centre on Substance Use, Vancouver, BC, Canada.
FAU - Yin Mok, Wing
AU  - Yin Mok W
AD  - British Columbia Centre on Substance Use, Vancouver, BC, Canada.
FAU - Eugenia Socias, M
AU  - Eugenia Socias M
AD  - British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of 
      Medicine, Faculty of Medicine, University of British Columbia, University of 
      British Columbia, Vancouver, BC, Canada. Electronic address: 
      bccsu-es@bccsu.ubc.ca.
CN  - OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse
LA  - eng
GR  - R25 DA037756/DA/NIDA NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
DEP - 20230518
PL  - Ireland
TA  - Drug Alcohol Depend
JT  - Drug and alcohol dependence
JID - 7513587
RN  - 0 (Analgesics, Opioid)
RN  - UC6VBE7V1Z (Methadone)
RN  - 0 (Buprenorphine, Naloxone Drug Combination)
RN  - 40D3SCR4GZ (Buprenorphine)
SB  - IM
MH  - Humans
MH  - Analgesics, Opioid/therapeutic use
MH  - Opiate Substitution Treatment/methods
MH  - Canada
MH  - *Opioid-Related Disorders/drug therapy/complications
MH  - Methadone/therapeutic use
MH  - Buprenorphine, Naloxone Drug Combination/therapeutic use
MH  - Prescriptions
MH  - *Buprenorphine/therapeutic use
OTO - NOTNLM
OT  - Buprenorphine
OT  - Methadone
OT  - Opioid agonist therapy
OT  - Opioid use disorder
OT  - Prescription opioids
OT  - Rotation
OT  - Switching
COIS- Declaration of Competing Interest E.W. is the Chief Medical Officer of a mental 
      health company called Numinus Wellness. D.J-A. receives study material from Tetra 
      Biopharma and Cardiol Therapeutics for trials funded by public institution in 
      Quebec and not related to opioid use disorder. B.L.F. receives or has received 
      support from Indivior, Pfizer Global Research Awards in Nicotine Dependence 
      (GRAND) programme, Brainsway, Bioprojet, Alkermes, Canopy, ACS and non-financial 
      support from Aurora for work outside this study. M.E.S. has received partial 
      support from Indivior's Investigator Initiated Study programme for work outside 
      this study. All other authors declare no competing interests.
EDAT- 2023/05/25 01:07
MHDA- 2023/06/19 13:08
CRDT- 2023/05/24 18:05
PHST- 2023/01/04 00:00 [received]
PHST- 2023/05/10 00:00 [revised]
PHST- 2023/05/11 00:00 [accepted]
PHST- 2023/06/19 13:08 [medline]
PHST- 2023/05/25 01:07 [pubmed]
PHST- 2023/05/24 18:05 [entrez]
AID - S0376-8716(23)00170-9 [pii]
AID - 10.1016/j.drugalcdep.2023.109932 [doi]
PST - ppublish
SO  - Drug Alcohol Depend. 2023 Jul 1;248:109932. doi: 
      10.1016/j.drugalcdep.2023.109932. Epub 2023 May 18.