Alford Daniel P, LaBelle Colleen T, Richardson Jessica M, O'Connell James J, Hohl Carole A, Cheng Debbie M, Samet Jeffrey H
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA 02118, USA.
J Gen Intern Med. 2007 Feb;22(2):171-6. doi: 10.1007/s11606-006-0023-1.
Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients.
To characterize the feasibility of OBOT-B in homeless relative to housed patients.
A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior.
Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P = .94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5-1.7) P = .8], utilization of counseling (homeless, 46%; housed, 49%; P = .95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P = .96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients.
Despite homeless opioid dependent patients' social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment.
尽管基于办公室的丁丙诺啡阿片类药物治疗（OBOT - B）已在美国的初级保健机构中成功实施，但尚未有其在无家可归患者中使用的报道。
描述OBOT - B在无家可归患者与有家可归患者中的可行性。
一项回顾性记录审查，研究2003年8月至2004年10月期间参与OBOT - B项目的无家可归患者和有家可归患者的治疗失败情况、药物使用情况、药物滥用治疗服务的利用情况以及护士护理经理（NCM）提供的临床支持强度。治疗失败定义为在完成药物诱导前逃走、因持续吸毒且不遵守强化治疗而在药物诱导后出院，或因破坏性行为而出院。
在12个月内登记的44名无家可归患者和41名有家可归患者中，无家可归患者更可能年龄较大、非白人、失业、感染艾滋病毒和丙型肝炎，且有精神疾病报告。无家可归患者的社会支持较少，有更多慢性药物滥用史，吸毒年限、戒毒尝试次数以及有美沙酮维持治疗史的比例高出3至6倍。无家可归患者（21%）和有家可归患者（22%）的治疗失败比例无差异（P = 0.94）。在12个月时，两组非法阿片类药物使用比例相似[优势比（OR），0.9（95%置信区间，0.5 - 1.7），P = 0.8]，接受咨询的比例（无家可归者为46%，有家可归者为49%；P = 0.95），以及参与互助小组的比例（无家可归者为25%，有家可归者为29%；P = 0.96）相似。在12个月时，36%的无家可归组患者不再无家可归。在治疗的第一个月，无家可归患者比有家可归患者需要NCM提供更多的临床支持。
尽管无家可归的阿片类药物依赖患者社会不稳定、合并症更多且药物使用更具长期性，但基于办公室的丁丙诺啡阿片类药物治疗在该人群中得以有效实施，在治疗失败、非法阿片类药物使用以及药物滥用治疗利用方面的结果与有家可归患者相当。
