Stein Michael D, Cioe Patricia, Friedmann Peter D
Division of General Internal Medicine, Rhode Island Hospital, Providence, RI 02903, USA.
J Gen Intern Med. 2005 Nov;20(11):1038-41. doi: 10.1111/j.1525-1497.2005.0228.x.
This study assesses the rate and predictors of treatment retention for primary care patients with opioid dependence-prescribed buprenorphine, a long-acting partial opioid agonist.
Observational cohort study of patients prescribed buprenorphine/naloxone and followed for 6 months in the period after the adoption of buprenophine/naloxone by a primary care practice in Rhode Island. Practice policy precluded patient discharges due to continuing drug use.
Patients (n=41) had a mean duration of opioid use of 15.7 years and most had a history of heroin use (63.4%). Thirty-nine percent of patients transferred from methadone maintenance. At 24 weeks, 59% remained in treatment. Nearly half of dropouts occurred in the first 30 days. Participants with opiate-positive toxicologies at week 1 were more likely to drop out of the program (P<.01) and had a significantly shorter retention time (P<.01) on average. Among other drug use and drug treatment variables, employment and addiction counseling during treatment were significantly associated with treatment retention (P=.03).
Retention rates in a real world, primary care-based buprenorphine maintenance practice reflect those reported in clinical trials. Abstinence during the first week of treatment and receipt of counseling were critical to patient retention.
本研究评估了开具长效部分阿片类激动剂丁丙诺啡的初级保健机构中，阿片类药物依赖患者的治疗保留率及预测因素。
对开具丁丙诺啡/纳洛酮的患者进行观察性队列研究，在罗德岛的一家初级保健机构采用丁丙诺啡/纳洛酮后的一段时间内对患者进行为期6个月的随访。实践政策禁止因持续吸毒而让患者出院。
患者（n = 41）的阿片类药物使用平均时长为15.7年，大多数患者有海洛因使用史（63.4%）。39%的患者从美沙酮维持治疗中转来。在24周时，59%的患者仍在接受治疗。近一半的退出者发生在最初30天内。第1周毒理学检测阿片类呈阳性的参与者更有可能退出该项目（P <.01），且平均保留时间显著更短（P <.01）。在其他药物使用和药物治疗变量中，治疗期间的就业和成瘾咨询与治疗保留显著相关（P = 0.03）。
在现实世界中，基于初级保健的丁丙诺啡维持治疗实践中的保留率反映了临床试验中的报告结果。治疗第一周的禁欲和接受咨询对患者保留至关重要。
