{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:47:18Z","timestamp":1791942438482,"version":"4.3.4"},"reference-count":49,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>A recent study found that homeless individuals with opioid use disorder (OUD) had a lower risk of relapse on extended\u2010release naltrexone (XR\u2010NTX) versus buprenorphine\u2013naloxone (BUP\u2010NX), whereas non\u2010homeless individuals had a lower risk of relapse on BUP\u2010NX. This secondary study examined differences in mediation pathways to medication effect between homeless and non\u2010homeless participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of an open\u2010label randomized controlled, 24\u2010week comparative effectiveness trial, 2014\u201317.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Eight community addiction treatment programs in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      English\u2010speaking adults with DSM\u20105 OUD, recruited during inpatient admission (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0570).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention(s)<\/jats:title>\n                    <jats:p>Randomization to monthly injection of XR\u2010NTX or daily sublingual BUP\u2010NX.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements(s)<\/jats:title>\n                    <jats:p>Mediation analysis estimated the direct effect of XR\u2010NTX versus BUP\u2010NX on relapse and indirect effect through mediators of medication adherence, use of illicit opioids, depressive symptoms and pain, separately by homeless status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>For the homeless subgroup, the protective indirect path contributed a 3.4 percentage point reduced risk of relapse [95% confidence interval (CI)\u00a0=\u00a0\u221212.0, 5.3] comparing XR\u2010NTX to BUP\u2010NX (explaining 21% of the total effect). For the non\u2010homeless subgroup, the indirect path contributed a 9.4 percentage point increased risk of relapse (95% CI\u00a0=\u00a03.1, 15.7) comparing XR\u2010NTX to BUP\u2010NX (explaining 57% of the total effect).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A novel approach to mediation analysis shows that much of the difference in medication effectiveness (extended\u2010release naltrexone versus buprenorphine\u2013naloxone) on opioid relapse among non\u2010homeless adults with opioid use disorder appears to be explained by mediators of adherence, illicit opioid use, depressive symptoms and pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.15377","type":"journal-article","created":{"date-parts":[[2020,12,19]],"date-time":"2020-12-19T06:53:35Z","timestamp":1608360815000},"page":"2094-2103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Explaining differential effects of medication for opioid use disorder using a novel approach incorporating mediating variables"],"prefix":"10.1111","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9417-7960","authenticated-orcid":false,"given":"Kara E.","family":"Rudolph","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Mailman School of Public Health Columbia University  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iv\u00e1n","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, Department of Population Health Sciences Weill Cornell Medicine  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nima S.","family":"Hejazi","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health University of California  Berkeley CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"van der Laan","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health University of California  Berkeley CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean X.","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine Columbia University and New York State Psychiatric Institute  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matisyahu","family":"Shulman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine Columbia University and New York State Psychiatric Institute  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine Columbia University and New York State Psychiatric Institute  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Rotrosen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine New York University  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2055-3425","authenticated-orcid":false,"given":"Edward V.","family":"Nunes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine Columbia University and New York State Psychiatric Institute  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.58.5.503"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0137-5"},{"key":"e_1_2_7_4_1","first-page":"1419","article-title":"Drug and opioid\u2010involved overdose deaths\u2014United States, 2013\u20132017","volume":"67","author":"Scholl L.","year":"2019","journal-title":"Morb Mort Wkly Rep"},{"key":"e_1_2_7_5_1","article-title":"Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence","author":"Mattick R. 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