PMID- 37899716 OWN - NLM STAT- MEDLINE DCOM- 20240311 LR - 20240312 IS - 1497-0015 (Electronic) IS - 0706-7437 (Print) IS - 0706-7437 (Linking) VI - 69 IP - 4 DP - 2024 Apr TI - Associations Between Buprenorphine\Naloxone and Methadone Treatment and non-Opioid Substance Use in Prescription-Type Opioid Use Disorder: Secondary Analyses From the OPTIMA Study: Associations entre le traitement avec la buprenorphine/naloxone et avec la methadone et l'utilisation de substances non opioides dans le trouble lie a l'usage d'opioides de type sur ordonnance : analyses secondaires de l'etude OPTIMA. PG - 252-263 LID - 10.1177/07067437231210796 [doi] AB - OBJECTIVES: There is limited evidence on how opioid agonist treatment (OAT) may affect psychoactive non-opioid substance use in prescription-type opioid use disorder (POUD) and whether this effect might explain OAT outcomes. We aimed to assess the effect of methadone on non-opioid substance use compared to buprenorphine/naloxone (BUP/NX), to explore whether non-opioid substance use is associated with opioid use and retention in treatment, and to test non-opioid use as a moderator of associations between methadone with retention in OAT and opioid use compared to BUP/NX. METHODS: This is a secondary analysis of data from the OPTIMA trial, an open-label, pragmatic, parallel, two-arm, pan-Canadian, multicentre, randomized-controlled trial to compare standard methadone model of care and flexible take-home dosing BUP/NX for POUD treatment. We studied the effect of methadone and BUP/NX on non-opioid substance use evaluated by urine drug screen (UDS) and by classes of non-opioid substances (i.e., tetrahydrocannabinol [THC], benzodiazepines, stimulants) (weeks 2-24) using adjusted generalized estimation equation (GEE). We studied the association between non-opioid substance-positive UDS and opioid-positive UDS and retention in treatment, using adjusted GEE and logistic regressions. RESULTS: Overall, methadone was not associated with non-opioid substance-positive UDS compared to BUP/NX (OR: 0.78; 95%CI, 0.41 to 1.48). When non-opioid substances were studied separately, methadone was associated with lower odds of benzodiazepine-positive UDS (OR: 0.63; 95% CI: 0.40 to 0.98) and THC-positive UDS (OR: 0.47; 95% CI: 0.28 to 0.77), but not with different odds of stimulant-positive UDS (OR: 1.29; 95% CI: 0.78 to 2.16) compared to BUP/NX. Substance-positive UDS, overall and separate classes, were not associated with opioid-positive UDS or retention in treatment. CONCLUSION: Methadone did not show a significant effect on overall non-opioid substance use in POUD compared to BUP/NX treatment but was associated with lower odds of benzodiazepine and THC use in particular. Non-opioid substance use did not predict OAT outcomes. Further research is needed to ascertain whether specific patterns of polysubstance use (quantity and frequency) may affect treatment outcomes. FAU - Bakouni, Hamzah AU - Bakouni H AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. FAU - Sharafi, Heidar AU - Sharafi H AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. FAU - Drouin, Sarah AU - Drouin S AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. FAU - Fortin, Raphaelle AU - Fortin R AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. FAU - Marsan, Stephanie AU - Marsan S AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. AD - Department of Family and Emergency Medicine, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. FAU - Brissette, Suzanne AU - Brissette S AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. AD - Department of Family and Emergency Medicine, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. FAU - Socias, Maria Eugenia AU - Socias ME AD - British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada. AD - Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Le Foll, Bernard AU - Le Foll B AD - Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. AD - Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. AD - Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. AD - Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. AD - Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada. AD - Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, 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 - 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, Quebec, Canada. AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. LA - eng PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20231030 PL - United States TA - Can J Psychiatry JT - Canadian journal of psychiatry. Revue canadienne de psychiatrie JID - 7904187 RN - UC6VBE7V1Z (Methadone) RN - 0 (Analgesics, Opioid) RN - 0 (Narcotic Antagonists) RN - 0 (Buprenorphine, Naloxone Drug Combination) RN - 12794-10-4 (Benzodiazepines) SB - IM MH - Humans MH - *Methadone/therapeutic use MH - Analgesics, Opioid/therapeutic use MH - Narcotic Antagonists/therapeutic use MH - Opiate Substitution Treatment MH - Canada/epidemiology MH - Buprenorphine, Naloxone Drug Combination/therapeutic use MH - *Opioid-Related Disorders/drug therapy MH - Benzodiazepines/therapeutic use MH - Prescriptions PMC - PMC10924583 OTO - NOTNLM OT - buprenorphine OT - buprenorphine OT - methadone OT - methadone OT - opioid replacement therapy OT - opioid use disorder OT - retention OT - retention OT - therapie de remplacement d'opioides OT - trouble d'utilisation d'opioide COIS- Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DJ-A receives study material from Cardiol Therapeutics and Exka for trials funded by public funding bodies. BLF has obtained funding from Pfizer Inc. (GRAND Awards, including salary support) for investigator-initiated projects. He has obtained funding from Indivior for a clinical trial sponsored by Indivior. He has in-kind donations of cannabis products from Aurora Cannabis Enterprises Inc. and study medication donations from Pfizer Inc. (varenicline for smoking cessation) and Bioprojet Pharma. He was also provided a coil for a Transcranial magnetic stimulation (TMS) study from Brainsway. He has obtained industry funding from Canopy Growth Corporation (through research grants handled by the Centre for Addiction and Mental Health and the University of Toronto), Bioprojet Pharma, Alcohol Countermeasure Systems (ACS), Alkermes and Universal Ibogaine. He has received in-kind donations of nabiximols from GW Pharmaceuticals for past studies funded by CIHR and the National Institutes of Health (NIH). He has participated in a session of a National Advisory Board Meeting (Emerging Trends BUP-XR) for Indivior Canada and has been consultant for Shinogi. MES has received partial support from Indivior's Investigator Initiated Study programme for work outside this study. SM has participated in a session of a national advisory board meeting for Indivior Canada as well as for Abbvie Canada.The OPTIMA clinical trial was registered on clinicaltrials.gov before the enrollment of the first participant (NCT03033732). EDAT- 2023/10/30 06:46 MHDA- 2024/03/11 06:43 PMCR- 2024/10/01 CRDT- 2023/10/30 04:14 PHST- 2024/10/01 00:00 [pmc-release] PHST- 2024/03/11 06:43 [medline] PHST- 2023/10/30 06:46 [pubmed] PHST- 2023/10/30 04:14 [entrez] AID - 10.1177_07067437231210796 [pii] AID - 10.1177/07067437231210796 [doi] PST - ppublish SO - Can J Psychiatry. 2024 Apr;69(4):252-263. doi: 10.1177/07067437231210796. Epub 2023 Oct 30.