PMID- 37697811 OWN - NLM STAT- MEDLINE DCOM- 20240216 LR - 20240311 IS - 1497-0015 (Electronic) IS - 0706-7437 (Print) IS - 0706-7437 (Linking) VI - 69 IP - 3 DP - 2024 Mar TI - The Association Between Self-Reported Anxiety and Retention in Opioid Agonist Therapy: Findings From a Canadian Pragmatic Trial. PG - 172-182 LID - 10.1177/07067437231194385 [doi] AB - BACKGROUND: Prescription-type opioid use disorder (POUD) is often accompanied by comorbid anxiety, yet the impact of anxiety on retention in opioid agonist therapy (OAT) is unclear. Therefore, this study investigated whether baseline anxiety severity affects retention in OAT and whether this effect differs by OAT type (methadone maintenance therapy (MMT) vs. buprenorphine/naloxone (BNX)). METHODS: This secondary analysis used data from a pan-Canadian randomized trial comparing flexible take-home dosing BNX and standard supervised MMT for 24 weeks. The study included 268 adults with POUD. Baseline anxiety was assessed using the Beck Anxiety Inventory (BAI), with BAI >/= 16 indicating moderate-to-severe anxiety. The primary outcomes were retention in assigned and any OAT at week 24. In addition, the impact of anxiety severity on retention was examined, and assigned OAT was considered an effect modifier. RESULTS: Of the participants, 176 (65%) reported moderate-to-severe baseline anxiety. In adjusted analyses, there was no significant difference in retention between those with BAI >/= 16 and those with BAI < 16 assigned (29% vs. 28%; odds ratio (OR) = 2.03, 95% confidence interval (CI) = 0.94-4.40; P = 0.07) or any OAT (35% vs. 34%; OR = 1.57, 95% CI = 0.77-3.21; P = 0.21). In addition, there was no significant effect modification by OAT type for retention in assigned (P = 0.41) or any OAT (P = 0.71). In adjusted analyses, greater retention in treatment was associated with BNX (vs. MMT), male gender identity (vs. female, transgender, or other), enrolment in the Quebec study site (vs. other sites), and absence of a positive urine drug screen for stimulants at baseline. CONCLUSIONS: Baseline anxiety severity did not significantly impact retention in OAT for adults with POUD, and there was no significant effect modification by OAT type. However, the overall retention rates were low, highlighting the need to develop new strategies to minimize the risk of attrition from treatment. CLINICAL TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov (NCT03033732). FAU - Bahji, Anees AU - Bahji A AUID- ORCID: 0000-0002-3490-314X AD - British Columbia Centre on Substance Use, Vancouver, BC, Canada. AD - Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. AD - Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. AD - Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. FAU - Bastien, Gabriel AU - Bastien G AUID- ORCID: 0000-0002-7969-9998 AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, QC, Canada. AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, QC, Canada. FAU - Bach, Paxton AU - Bach P AD - British Columbia Centre on Substance Use, Vancouver, BC, Canada. AD - Department of Medicine, University of British Columbia, Vancouver, BC, Canada. FAU - Choi, JinCheol AU - Choi J AUID- ORCID: 0000-0001-5133-1051 AD - British Columbia Centre on Substance Use, Vancouver, BC, Canada. FAU - Le Foll, Bernard AU - Le Foll B AD - Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, ON, Canada. 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. FAU - Lim, Ron AU - Lim R AD - Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. AD - Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. FAU - Jutras-Aswad, Didier AU - Jutras-Aswad D AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, QC, Canada. AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, QC, Canada. 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, University of British Columbia, Vancouver, BC, Canada. LA - eng SI - ClinicalTrials.gov/NCT03033732 GR - R25 DA037756/DA/NIDA NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230912 PL - United States TA - Can J Psychiatry JT - Canadian journal of psychiatry. Revue canadienne de psychiatrie JID - 7904187 RN - 0 (Analgesics, Opioid) RN - UC6VBE7V1Z (Methadone) RN - 0 (Buprenorphine, Naloxone Drug Combination) SB - IM MH - Adult MH - Female MH - Male MH - Humans MH - *Analgesics, Opioid/therapeutic use MH - Methadone MH - Opiate Substitution Treatment MH - Self Report MH - Canada/epidemiology MH - Gender Identity MH - *Opioid-Related Disorders/drug therapy/epidemiology/rehabilitation MH - Buprenorphine, Naloxone Drug Combination/therapeutic use MH - Anxiety/epidemiology PMC - PMC10874605 OTO - NOTNLM OT - analgesics OT - anxiety disorder OT - buprenorphine OT - humans OT - methadone OT - naloxone drug combination OT - opioid OT - opioid-related disorder OT - randomized controlled trial COIS- Declaration of Conflicting Interests The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Bahji receives a small honorarium for teaching undergraduate and postgraduate medical trainees in the Cumming School of Medicine at the University of Calgary. In addition, Dr. Bahji is an unpaid member of the Canadian Network for Mood and Anxiety Treatments editorial committee, the International Society of Addiction Journal Editors, the Canadian Society of Addiction Medicine policy committee, and the Addiction Psychiatry section of the Canadian Psychiatric Association. Dr. Bahji is also an unpaid associate editor of the Canadian Journal of Addiction and a mental health educator for TED-Ed, where he receives a small honorarium for supporting online educational content. Finally, Dr. Bahji does not report royalties, licenses, consulting fees, payment or honoraria for lectures or presentations, speaker's bureaus, manuscript writing, expert testimony, patents, or participation on other boards. In addition, MES has received partial support from Indivior's Investigator-Initiated Study program for work outside this study. DJA receives investigational products from Cardiol Therapeutics for a clinical trial funded by the Quebec Ministry of Health and Social Services. All other authors declare no competing interests. EDAT- 2023/09/12 06:41 MHDA- 2024/02/16 06:42 PMCR- 2023/09/12 CRDT- 2023/09/12 03:09 PHST- 2024/02/16 06:42 [medline] PHST- 2023/09/12 06:41 [pubmed] PHST- 2023/09/12 03:09 [entrez] PHST- 2023/09/12 00:00 [pmc-release] AID - 10.1177_07067437231194385 [pii] AID - 10.1177/07067437231194385 [doi] PST - ppublish SO - Can J Psychiatry. 2024 Mar;69(3):172-182. doi: 10.1177/07067437231194385. Epub 2023 Sep 12.