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Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials

The impact of agonist dose and of physician, staff and patient engagement on treatment have not been evaluated together in an analysis of treatment for opioid use disorder. Our hypotheses were that greater agonist dose and therapeutic engagement would be associated with reduced illicit opiate use in...

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Autores principales: Bergen, Andrew W., Baurley, James W., Ervin, Carolyn M., McMahan, Christopher S., Bible, Joe, Stafford, Randall S., Mudumbai, Seshadri C., Saxon, Andrew J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8998781/
https://www.ncbi.nlm.nih.gov/pubmed/35409790
http://dx.doi.org/10.3390/ijerph19074106
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author Bergen, Andrew W.
Baurley, James W.
Ervin, Carolyn M.
McMahan, Christopher S.
Bible, Joe
Stafford, Randall S.
Mudumbai, Seshadri C.
Saxon, Andrew J.
author_facet Bergen, Andrew W.
Baurley, James W.
Ervin, Carolyn M.
McMahan, Christopher S.
Bible, Joe
Stafford, Randall S.
Mudumbai, Seshadri C.
Saxon, Andrew J.
author_sort Bergen, Andrew W.
collection PubMed
description The impact of agonist dose and of physician, staff and patient engagement on treatment have not been evaluated together in an analysis of treatment for opioid use disorder. Our hypotheses were that greater agonist dose and therapeutic engagement would be associated with reduced illicit opiate use in a time-dependent manner. Publicly-available treatment data from six buprenorphine efficacy and safety trials from the Federally-supported Clinical Trials Network were used to derive treatment variables. Three novel predictors were constructed to capture the time weighted effects of buprenorphine dosage (mg buprenorphine per day), dosing protocol (whether physician could adjust dose), and clinic visits (whether patient attended clinic). We used time-in-trial as a predictor to account for the therapeutic benefits of treatment persistence. The outcome was illicit opiate use defined by self-report or urinalysis. Trial participants (N = 3022 patients with opioid dependence, mean age 36 years, 33% female, 14% Black, 16% Hispanic) were analyzed using a generalized linear mixed model. Treatment variables dose, Odds Ratio (OR) = 0.63 (95% Confidence Interval (95%CI) 0.59–0.67), dosing protocol, OR = 0.70 (95%CI 0.65–0.76), time-in-trial, OR = 0.75 (95%CI 0.71–0.80) and clinic visits, OR = 0.81 (95%CI 0.76–0.87) were significant (p-values < 0.001) protective factors. Treatment implications support higher doses of buprenorphine and greater engagement of patients with providers and clinic staff.
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spelling pubmed-89987812022-04-12 Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials Bergen, Andrew W. Baurley, James W. Ervin, Carolyn M. McMahan, Christopher S. Bible, Joe Stafford, Randall S. Mudumbai, Seshadri C. Saxon, Andrew J. Int J Environ Res Public Health Article The impact of agonist dose and of physician, staff and patient engagement on treatment have not been evaluated together in an analysis of treatment for opioid use disorder. Our hypotheses were that greater agonist dose and therapeutic engagement would be associated with reduced illicit opiate use in a time-dependent manner. Publicly-available treatment data from six buprenorphine efficacy and safety trials from the Federally-supported Clinical Trials Network were used to derive treatment variables. Three novel predictors were constructed to capture the time weighted effects of buprenorphine dosage (mg buprenorphine per day), dosing protocol (whether physician could adjust dose), and clinic visits (whether patient attended clinic). We used time-in-trial as a predictor to account for the therapeutic benefits of treatment persistence. The outcome was illicit opiate use defined by self-report or urinalysis. Trial participants (N = 3022 patients with opioid dependence, mean age 36 years, 33% female, 14% Black, 16% Hispanic) were analyzed using a generalized linear mixed model. Treatment variables dose, Odds Ratio (OR) = 0.63 (95% Confidence Interval (95%CI) 0.59–0.67), dosing protocol, OR = 0.70 (95%CI 0.65–0.76), time-in-trial, OR = 0.75 (95%CI 0.71–0.80) and clinic visits, OR = 0.81 (95%CI 0.76–0.87) were significant (p-values < 0.001) protective factors. Treatment implications support higher doses of buprenorphine and greater engagement of patients with providers and clinic staff. MDPI 2022-03-30 /pmc/articles/PMC8998781/ /pubmed/35409790 http://dx.doi.org/10.3390/ijerph19074106 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bergen, Andrew W.
Baurley, James W.
Ervin, Carolyn M.
McMahan, Christopher S.
Bible, Joe
Stafford, Randall S.
Mudumbai, Seshadri C.
Saxon, Andrew J.
Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials
title Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials
title_full Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials
title_fullStr Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials
title_full_unstemmed Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials
title_short Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials
title_sort effects of buprenorphine dose and therapeutic engagement on illicit opiate use in opioid use disorder treatment trials
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8998781/
https://www.ncbi.nlm.nih.gov/pubmed/35409790
http://dx.doi.org/10.3390/ijerph19074106
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