Clinical and psychosocial outcomes by sex among individuals prescribed buprenorphine-naloxone (BUP-NX) or extended-release naltrexone (XR-NTX) for opioid use disorder.
Journal
The American journal on addictions
ISSN: 1521-0391
Titre abrégé: Am J Addict
Pays: England
ID NLM: 9208821
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
revised:
18
07
2023
received:
17
04
2023
accepted:
05
08
2023
medline:
2
11
2023
pubmed:
16
8
2023
entrez:
16
8
2023
Statut:
ppublish
Résumé
Limited research has explored sex differences in opioid use disorder medication (MOUD) treatment outcomes. The purpose of this study was to examine MOUD initiation onto buprenorphine-naloxone (BUP-NX) versus extended-release naltrexone (XR-NTX) by sex, and sex differences in clinical and psychosocial outcomes. Using data from a 24-week open-label comparative effectiveness trial of BUP-NX or XR-NTX, this study examined MOUD initiation (i.e., receiving a minimum one XR-NTX injection or first BUP-NX dose) and 24-week self-report outcomes. We used regression models to estimate the probability of MOUD initiation failure among the intent-to-treat sample (N = 570), and the main and interaction effects of sex on outcomes of interest among the subsample of participants who successfully initiated MOUD (n = 474). In the intent-to-treat sample, the odds of treatment initiation failure were not significantly different by sex. In the subsample of successful MOUD initiates, the effect of treatment on employment at week 24 was significantly moderated by sex (p = .003); odds of employment were not significantly different among males by MOUD type; females randomized to XR-NTX versus BUP-NX had 4.63 times greater odds of employment (p < .001). Males had significantly lower odds of past 30-day exchanging sex for drugs versus females (adjusted odds ratios [aOR] = 0.10, p = .004), controlling for treatment and baseline outcomes. Further research should explore how to integrate employment support into OUD treatment to improve patient outcomes, particularly among women. The current study addressed gaps in the literature by examining sex differences in MOUD initiation and diverse treatment outcomes in a large, national sample.
Sections du résumé
BACKGROUND AND OBJECTIVES
Limited research has explored sex differences in opioid use disorder medication (MOUD) treatment outcomes. The purpose of this study was to examine MOUD initiation onto buprenorphine-naloxone (BUP-NX) versus extended-release naltrexone (XR-NTX) by sex, and sex differences in clinical and psychosocial outcomes.
METHODS
Using data from a 24-week open-label comparative effectiveness trial of BUP-NX or XR-NTX, this study examined MOUD initiation (i.e., receiving a minimum one XR-NTX injection or first BUP-NX dose) and 24-week self-report outcomes. We used regression models to estimate the probability of MOUD initiation failure among the intent-to-treat sample (N = 570), and the main and interaction effects of sex on outcomes of interest among the subsample of participants who successfully initiated MOUD (n = 474).
RESULTS
In the intent-to-treat sample, the odds of treatment initiation failure were not significantly different by sex. In the subsample of successful MOUD initiates, the effect of treatment on employment at week 24 was significantly moderated by sex (p = .003); odds of employment were not significantly different among males by MOUD type; females randomized to XR-NTX versus BUP-NX had 4.63 times greater odds of employment (p < .001). Males had significantly lower odds of past 30-day exchanging sex for drugs versus females (adjusted odds ratios [aOR] = 0.10, p = .004), controlling for treatment and baseline outcomes.
DISCUSSION AND CONCLUSIONS
Further research should explore how to integrate employment support into OUD treatment to improve patient outcomes, particularly among women.
SCIENTIFIC SIGNIFICANCE
The current study addressed gaps in the literature by examining sex differences in MOUD initiation and diverse treatment outcomes in a large, national sample.
Substances chimiques
Buprenorphine, Naloxone Drug Combination
0
Delayed-Action Preparations
0
Naltrexone
5S6W795CQM
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
584-592Subventions
Organisme : NIDA NIH HHS
ID : UG1 DA013720
Pays : United States
Organisme : NIDA NIH HHS
ID : UG1 DA013714
Pays : United States
Organisme : NIDA NIH HHS
ID : UG1 DA013034
Pays : United States
Organisme : NIDA NIH HHS
ID : UG1 DA015831
Pays : United States
Organisme : NIDA NIH HHS
ID : UG1 DA013035
Pays : United States
Organisme : NIDA NIH HHS
ID : U10DA013045
Pays : United States
Organisme : NIDA NIH HHS
ID : U10DA015833
Pays : United States
Organisme : NIDA NIH HHS
ID : UG1DA013720
Pays : United States
Organisme : NIDA NIH HHS
ID : UG1DA013732
Pays : United States
Organisme : NIDA NIH HHS
ID : UG1DA015831
Pays : United States
Informations de copyright
© 2023 The American Academy of Addiction Psychiatry (AAAP).
Références
Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 2020. Accessed February 10, 2022. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf
Kerridge BT, Saha TD, Chou SP, et al. Gender and nonmedical prescription opioid use and DSM-5 nonmedical prescription opioid use disorder: results from the National epidemiologic survey on alcohol and related Conditions-III. Drug Alcohol Depend. 2015;156:47-56.
McHugh RK, Votaw VR, Sugarman DE, Greenfield SF. Sex and gender differences in substance use disorders. Clin Psychol Rev. 2018;66:12-23.
Campbell ANC, Barbosa-Leiker C, Hatch-Maillette M, et al. Gender differences in demographic and clinical characteristics of patients with opioid use disorder entering a comparative effectiveness medication trial. Am J Addict. 2018;27(6):465-470.
Ochoa E, Madoz-Gúrpide A, Salvador E. [Gender differences in the treatment of the opiate dependence with naltrexone]. Actas Esp Psiquiatr. 2008;36(4):197-204.
Herbeck DM, Jeter KE, Cousins SJ, Abdelmaksoud R, Crèvecoeur-MacPhail D. Gender differences in treatment and clinical characteristics among patients receiving extended release naltrexone. J Addict Dis. 2016;35(4):305-314.
Bawor M, Dennis BB, Bhalerao A, et al. Sex differences in outcomes of methadone maintenance treatment for opioid use disorder: a systematic review and meta-analysis. Canadian medical association open access. Journal. 2015;3(3):E344-E351.
Barbosa-Leiker C, Campbell ANC, Pavlicova M, et al. Substance use and mental health in emerging adult vs older adult men and women with opioid use disorder. Am J Addict. 2020;29(6):536-542.
Di Paola A, Taweh N, Biondi BE, et al. Gender differences among persons entering medication treatment for opioid use disorder in the community. Am J Addict. 2022;31(5):390-395.
McHugh RK, DeVito EE, Dodd D, et al. Gender differences in a clinical trial for prescription opioid dependence. J Subst Abuse Treat. 2013;45(1):38-43.
Ling S, Mangaoil R, Cleverley K, Sproule B, Puts M. A systematic review of sex differences in treatment outcomes among people with opioid use disorder receiving buprenorphine maintenance versus other treatment conditions. Drug Alcohol Depend. 2019;197:168-182.
Barbosa-Leiker C, Campbell AN, McHugh RK, Guille C, Greenfield SF. Opioid use disorder in women and the implications for treatment. Psychiatr Res Clin Pract. 2021;3:3-11.
Greenfield SF, Brooks AJ, Gordon SM, et al. Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug Alcohol Depend. 2007;86(1):1-21.
Mazure CM, Fiellin DA. Women and opioids: something different is happening here. Lancet. 2018;392(10141):9-11.
McKee SA, McRae-Clark AL. Consideration of sex and gender differences in addiction medication response. Biol Sex Differ. 2022;13(1):34.
Sugarman DE, Meyer LE, Reilly ME, Greenfield SF. Feasibility and acceptability of a web-based, gender-specific intervention for women with substance use disorders. J Women's Health. 2020;29(5):636-646.
Lee JD, Nunes Jr. EV, Novo P, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X: BOT): a multicentre, open-label, randomised controlled trial. Lancet. 2018;391(10118):309-318.
Shulman M, Choo T-H, Scodes J, et al. Association between methadone or buprenorphine use during medically supervised opioid withdrawal and extended-release injectable naltrexone induction failure. J Subst Abuse Treat. 2021;124:108292.
Sobell L, Sobell M. Alcohol Timeline Followback Users' Manual. Addiction Research Foundation; 1995.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56-62.
Rabin R, Charro F. EQ-SD: a measure of health status from the EuroQol group. Ann Med. 2001;33(5):337-343.
Mannelli P, Wu L-T, Peindl KS, Swartz MS, Woody GE. Extended release naltrexone injection is performed in the majority of opioid dependent patients receiving outpatient induction: a very low dose naltrexone and buprenorphine open label trial. Drug Alcohol Depend. 2014;138:83-88.
Sullivan M, Bisaga A, Pavlicova M, et al. Long-acting injectable naltrexone induction: a randomized trial of outpatient opioid detoxification with naltrexone versus buprenorphine. Am J Psychiatry. 2017;174(5):459-467.
Khan SS, Secades-Villa R, Okuda M, et al. Gender differences in cannabis use disorders: results from The National epidemiologic survey of alcohol and related conditions. Drug Alcohol Depend. 2013;130(1-3):101-108.
Verissimo ADO, Grella CE. Influence of gender and race/ethnicity on perceived barriers to help-seeking for alcohol or drug problems. J Subst Abuse Treat. 2017;75:54-61.
Martinson K, McDonald D, Berninger A, Wasserman K. Building Evidence-Based Strategies to Improve Employment Outcomes for Individuals with Substance Use Disorders. OPRE Report 171. Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services; 2020.
National Academies of Sciences E, and Medicine. Measuring Sex, Gender Identity, and Sexual Orientation. The National Academies Press; 2022.
Hughto JMW, Quinn EK, Dunbar MS, Rose AJ, Shireman TI, Jasuja GK. Prevalence and co-occurrence of alcohol, nicotine, and other substance use disorder diagnoses among US transgender and cisgender adults. JAMA Network Open. 2021;4(2):e2036512.
Reisner SL, Pardo ST, Gamarel KE, Hughto JMW, Pardee DJ, Keo-Meier CL. Substance use to cope with stigma in healthcare among US female-to-male trans masculine adults. LGBT Health. 2015;2(4):324-332.