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The purpose of this study was to examine MOUD initiation onto buprenorphine\u2010naloxone (BUP\u2010NX) versus extended\u2010release naltrexone (XR\u2010NTX) by sex, and sex differences in clinical and psychosocial outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using data from a 24\u2010week open\u2010label comparative effectiveness trial of BUP\u2010NX or XR\u2010NTX, this study examined MOUD initiation (i.e., receiving a minimum one XR\u2010NTX injection or first BUP\u2010NX dose) and 24\u2010week self\u2010report outcomes. We used regression models to estimate the probability of MOUD initiation failure among the intent\u2010to\u2010treat sample (<jats:italic>N<\/jats:italic>\u2009=\u2009570), and the main and interaction effects of sex on outcomes of interest among the subsample of participants who successfully initiated MOUD (<jats:italic>n<\/jats:italic>\u2009=\u2009474).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the intent\u2010to\u2010treat 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 (<jats:italic>p<\/jats:italic>\u2009=\u2009.003); odds of employment were not significantly different among males by MOUD type; females randomized to XR\u2010NTX versus BUP\u2010NX had 4.63 times greater odds of employment (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Males had significantly lower odds of past 30\u2010day exchanging sex for drugs versus females (adjusted odds ratios [aOR]\u2009=\u20090.10, <jats:italic>p<\/jats:italic>\u2009=\u2009.004), controlling for treatment and baseline outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>Further research should explore how to integrate employment support into OUD treatment to improve patient outcomes, particularly among women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Scientific Significance<\/jats:title><jats:p>The current study addressed gaps in the literature by examining sex differences in MOUD initiation and diverse treatment outcomes in a large, national sample.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajad.13463","type":"journal-article","created":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T05:06:24Z","timestamp":1692421584000},"page":"584-592","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical and psychosocial outcomes by sex among individuals prescribed buprenorphine\u2010naloxone (BUP\u2010NX) or extended\u2010release naltrexone (XR\u2010NTX) for opioid use disorder"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1176-5183","authenticated-orcid":false,"given":"Margaret","family":"Paschen\u2010Wolff","sequence":"first","affiliation":[{"name":"New York State Psychiatric Institute, Department of Psychiatry, Division on Substance Use Disorders Columbia University Irving Medical Center New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9387-1416","authenticated-orcid":false,"given":"Shelly F.","family":"Greenfield","sequence":"additional","affiliation":[{"name":"McLean Hospital Belmont Massachusetts USA"},{"name":"Department of Psychiatry Harvard Medical School Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3011-8697","authenticated-orcid":false,"given":"R.","family":"Kathryn McHugh","sequence":"additional","affiliation":[{"name":"McLean Hospital Belmont Massachusetts USA"},{"name":"Department of Psychiatry Harvard Medical School Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Burlew","sequence":"additional","affiliation":[{"name":"Department of Psychology, College of Arts &amp; Sciences University of Cincinnati Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Pavlicova","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Columbia University Mailman School of Public Health New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tse\u2010Hwei","family":"Choo","sequence":"additional","affiliation":[{"name":"Mental Health Data Science Division New York State Psychiatric Institute and Columbia University New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5576-4150","authenticated-orcid":false,"given":"Celestina","family":"Barbosa\u2010Leiker","sequence":"additional","affiliation":[{"name":"College of Nursing Washington State University Spokane Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lesia M.","family":"Ruglass","sequence":"additional","affiliation":[{"name":"Department of Psychology City College of New York New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Mennenga","sequence":"additional","affiliation":[{"name":"Department of Psychiatry New York University Grossman School of Medicine New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Rotrosen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry New York University Grossman School of Medicine New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2055-3425","authenticated-orcid":false,"given":"Edward V.","family":"Nunes","sequence":"additional","affiliation":[{"name":"New York State Psychiatric Institute, Department of Psychiatry, Division on Substance Use Disorders Columbia University Irving Medical Center New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4247-9980","authenticated-orcid":false,"given":"Aimee N. 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