PMID- 37308805 OWN - NLM STAT- MEDLINE DCOM- 20230825 LR - 20231215 IS - 1521-0391 (Electronic) IS - 1055-0496 (Linking) VI - 32 IP - 5 DP - 2023 Sep TI - Associations of methadone and buprenorphine-naloxone doses with unregulated opioid use, treatment retention, and adverse events in prescription-type opioid use disorders: Exploratory analyses of the OPTIMA study. PG - 469-478 LID - 10.1111/ajad.13439 [doi] AB - BACKGROUND AND OBJECTIVES: Buprenorphine/naloxone (BUP-NX) and methadone are used to treat opioid use disorder (OUD), yet there is insufficient evidence on the impact of doses on interventions' effectiveness and safety when treating OUD attributable to other opioids than heroin. METHODS: We explored associations between methadone and BUP-NX doses and treatment outcomes using data from OPTIMA, a 24-week, pragmatic, open-label, multicenter, pan-Canadian, randomized controlled, two-arm parallel trial with participants (N = 272) with OUD who primarily use opioids other than heroin. Participants were randomized to receive flexible take-home BUP-NX (n = 138) or standard supervised methadone treatment (n = 134). We examined associations between highest BUP-NX and methadone doses, and (1) percentage of opioid-positive urine drug screens (UDS); (2) retention in the assigned treatment; and (3) adverse events (AEs). RESULTS: The mean (SD) highest BUP-NX and methadone dose were 17.31 mg/day (8.59) and 67.70 mg/day (34.70). BUP-NX and methadone doses were not associated with opioid-positive UDS percentages or AEs. Methadone dose was associated with higher retention in treatment (odds ratio [OR]: 1.025; 95% confidence interval [CI]: 1.010; 1.041), while BUP-NX dose was not (OR: 1.055; 95% CI: 0.990; 1.124). Higher methadone doses (70-110 mg/day) offered higher odds of treatment retention. DISCUSSION AND CONCLUSION: Methadone dose was associated with higher retention, which may be related to its full micro-opioid receptor agonism. Future research should notably ascertain the effect of pace of titration on a wide range of outcomes. SCIENTIFIC SIGNIFICANCE: Our results extend previous findings of high doses of methadone increasing retention to be applied in our population using opioids other than heroin, including highly potent opioids. CI - (c) 2023 The Authors. The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry (AAAP). FAU - Bakouni, Hamzah AU - Bakouni H AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Quebec, Montreal, Canada. FAU - McAnulty, Christina AU - McAnulty C AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Quebec, Montreal, Canada. AD - Department of Psychiatry and Addictology, Universite de Montreal, Quebec, Montreal, Canada. FAU - Tatar, Ovidiu AU - Tatar O AUID- ORCID: 0000-0003-1886-6390 AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Quebec, Montreal, Canada. AD - Department of Psychiatry and Addictology, Universite de Montreal, Quebec, Montreal, Canada. FAU - Socias, M Eugenia AU - Socias ME AD - British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada. AD - Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada. FAU - Le Foll, Bernard AU - Le Foll B AD - Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Ontario, Toronto, Canada. AD - Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Ontario, Toronto, Canada. AD - Department of Psychiatry, University of Toronto, Ontario, Toronto, Canada. AD - Dalla Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada. AD - Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Ontario, Toronto, Canada. AD - Waypoint Research Institute, Waypoint Centre for Mental Health Care, Ontario, Penetanguishene, Canada. FAU - Lim, Ron AU - Lim R AD - Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. FAU - Ahamad, Keith AU - Ahamad K AD - British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada. AD - Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, 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), Quebec, Montreal, Canada. AD - Department of Psychiatry and Addictology, Universite de Montreal, Quebec, Montreal, Canada. CN - OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse LA - eng GR - SMN-139148/CIHR/Canada GR - SMN-139149/CIHR/Canada GR - SMN-139150/CIHR/Canada GR - SMN-139151/CIHR/Canada PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20230612 PL - England TA - Am J Addict JT - The American journal on addictions JID - 9208821 RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - UC6VBE7V1Z (Methadone) RN - 0 (Analgesics, Opioid) RN - 70D95007SX (Heroin) RN - 40D3SCR4GZ (Buprenorphine) RN - 0 (Narcotic Antagonists) SB - IM MH - Humans MH - Buprenorphine, Naloxone Drug Combination/therapeutic use MH - Methadone/adverse effects MH - Analgesics, Opioid/adverse effects MH - Heroin MH - Opiate Substitution Treatment/adverse effects/methods MH - Canada MH - *Opioid-Related Disorders/drug therapy MH - *Buprenorphine/adverse effects MH - Prescriptions MH - Narcotic Antagonists/adverse effects EDAT- 2023/06/13 01:13 MHDA- 2023/08/25 06:42 CRDT- 2023/06/12 23:30 PHST- 2023/03/13 00:00 [revised] PHST- 2022/11/26 00:00 [received] PHST- 2023/05/23 00:00 [accepted] PHST- 2023/08/25 06:42 [medline] PHST- 2023/06/13 01:13 [pubmed] PHST- 2023/06/12 23:30 [entrez] AID - 10.1111/ajad.13439 [doi] PST - ppublish SO - Am J Addict. 2023 Sep;32(5):469-478. doi: 10.1111/ajad.13439. Epub 2023 Jun 12.