Randomized Controlled Trial

. 2023 Sep;32(5):469-478.

doi: 10.1111/ajad.13439. Epub 2023 Jun 12.

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

Hamzah Bakouni¹, Christina McAnulty^{1

2}, Ovidiu Tatar^{1

2}, M Eugenia Socias^{3

4}, Bernard Le Foll^{5

6

7

8

9

10}, Ron Lim¹¹, Keith Ahamad^{3

12}, Didier Jutras-Aswad^{1

2}; OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse

Affiliations

¹ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec, Montréal, Canada.
² Department of Psychiatry and Addictology, Université de Montréal, Québec, Montréal, Canada.
³ British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
⁴ Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.
⁵ Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Ontario, Toronto, Canada.
⁶ Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Ontario, Toronto, Canada.
⁷ Department of Psychiatry, University of Toronto, Ontario, Toronto, Canada.
⁸ Dalla Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada.
⁹ Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Ontario, Toronto, Canada.
¹⁰ Waypoint Research Institute, Waypoint Centre for Mental Health Care, Ontario, Penetanguishene, Canada.
¹¹ Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹² Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 37308805
DOI: 10.1111/ajad.13439

Randomized Controlled Trial

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

Hamzah Bakouni et al. Am J Addict. 2023 Sep.

. 2023 Sep;32(5):469-478.

doi: 10.1111/ajad.13439. Epub 2023 Jun 12.

Authors

Affiliations

¹ Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec, Montréal, Canada.
² Department of Psychiatry and Addictology, Université de Montréal, Québec, Montréal, Canada.
³ British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
⁴ Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.
⁵ Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Ontario, Toronto, Canada.
⁶ Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Ontario, Toronto, Canada.
⁷ Department of Psychiatry, University of Toronto, Ontario, Toronto, Canada.
⁸ Dalla Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada.
⁹ Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Ontario, Toronto, Canada.
¹⁰ Waypoint Research Institute, Waypoint Centre for Mental Health Care, Ontario, Penetanguishene, Canada.
¹¹ Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹² Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 37308805
DOI: 10.1111/ajad.13439

Abstract

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 µ-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.

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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

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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

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