Roux Perrine, Villes Virgine, Blanche Jerome, Bry Didier, Spire Bruno, Feroni Isabelle, Carrieri M Patrizia
Inserm, U912 Economic & Social Sciences, Health Systems & Societies, Marseille, France.
Drug Alcohol Depend. 2008 Sep 1;97(1-2):105-13. doi: 10.1016/j.drugalcdep.2008.03.025. Epub 2008 May 13.
Though the introduction of office-based buprenorphine has greatly contributed to stem the HIV epidemic since 1995, concerns have been raised about the intravenous use of buprenorphine even in patients on substitution treatment. The aim of this study was to identify which factors are predictive of buprenorphine injection in patients receiving office-based buprenorphine.
Subazur is a survey consisting of two longitudinal assessments of 111 stabilized patients receiving office-based buprenorphine in southeastern France.
Patients were interviewed by phone at enrolment and 6 months later about social characteristics, addictive behaviors, treatment experiences, overdoses and suicide ideation or attempt. A logistic regression based on generalized estimating equations (GEE) was used to identify factors associated with buprenorphine injection at any interview.
Among the 111 patients (32% women, mean age 38 years), 36 reported buprenorphine injection after having started treatment initiation in 40 interviews. After adjustment for time since first injection, individuals perceiving their prescribed dosage as inadequate (OR=2.6 95%CI[1.2-5.7]) and those reporting a history of suicide ideation or attempt (OR=2.7 95%CI[1.1-7.0]) had approximately a three-fold higher risk of injecting buprenorphine.
Providing adequate care for both drug dependence and psychiatric comorbidities in primary care is a major issue. Like heroin use during methadone treatment, buprenorphine injection should be regarded more as a response to inadequate care than simply as a "misuse". A re-assessment of the treatment efficacy through a possible dosage increase or a switch to methadone could potentially reduce diversion and assure sustained adherence to OST.
自1995年以来，基于门诊的丁丙诺啡的引入对遏制艾滋病流行做出了巨大贡献，但即便在接受替代治疗的患者中，丁丙诺啡的静脉注射使用也引发了担忧。本研究的目的是确定哪些因素可预测接受门诊丁丙诺啡治疗的患者会注射丁丙诺啡。
Subazur是一项调查，对法国东南部111名接受门诊丁丙诺啡治疗且病情稳定的患者进行了两次纵向评估。
在入组时及6个月后通过电话对患者进行访谈，内容包括社会特征、成瘾行为、治疗经历、过量用药以及自杀意念或自杀未遂情况。使用基于广义估计方程（GEE）的逻辑回归来确定在任何一次访谈中与丁丙诺啡注射相关的因素。
在111名患者（32%为女性，平均年龄38岁）中，有36名在40次访谈中报告在开始治疗后注射过丁丙诺啡。在调整首次注射后的时间后，认为规定剂量不足的个体（比值比=2.6，95%置信区间[1.2 - 5.7]）以及报告有自杀意念或自杀未遂史的个体（比值比=2.7，95%置信区间[1.1 - 7.0]）注射丁丙诺啡的风险大约高出两倍。
在初级保健中为药物依赖和精神疾病合并症提供充分治疗是一个重大问题。与美沙酮治疗期间使用海洛因一样，丁丙诺啡注射应更多地被视为对治疗不足的一种反应，而不仅仅是“滥用”。通过可能增加剂量或改用美沙酮对治疗效果进行重新评估，可能会减少药物转移并确保持续坚持接受口服阿片类药物替代治疗。
