From BioPsych Consulting, Califon, NJ.
J Addict Med. 2007 Jun;1(2):104-10. doi: 10.1097/ADM.0b013e31809b5df2.
Office-based buprenorphine-naloxone (Suboxone) treatment in the United States has significantly improved access to safe and effective opioid-dependence therapy. Little data from physicians' experiences prescribing Suboxone in private offices have been available. This retrospective chart review describes a family practitioner's first 2 years of clinical experience prescribing Suboxone for opioid dependence to 71 patients in a private office. After directly observed rapid office dose induction, Suboxone prescriptions were given monthly after evidence of continued stability. Urine was screened regularly and patients were referred for counseling and other ancillary services. Patients averaged 32 years old, 4.3 years of opioid dependence, and were primarily white (93%) and employed (70%). Fifty-two percent used heroin primarily (most by injection), and 70% had no agonist substitution therapy history. Almost half (47%) paid for their own treatment. Compliance during dose induction was excellent. Suboxone maintenance doses averaged 10 (range, 2-24) mg per day. More than 80% of urine samples were opioid-negative after Suboxone treatment began, although urinalysis did not always include a test for oxycodone. Seventy-five percent had successful outcomes by remaining in Suboxone treatment (43%), tapering successfully (21%), transferring to methadone maintenance (7%), or inpatient treatment (4%). Fifty-eight percent reported receiving counseling. Almost all (85%) paid their fees on time. There were no safety, medication abuse, or diversion issues detected. Overall, office-based Suboxone therapy was easily implemented and the physician considered the experience excellent. Suboxone maintenance was associated with good treatment retention and significantly reduced opioid use, and it is helping to reach patients, including injection drug users, without histories of agonist substitution therapy.
美国的基于办公室的丁丙诺啡-纳洛酮（Suboxone）治疗显著改善了安全有效的阿片类药物依赖治疗的可及性。来自私人诊所医生开具 Suboxone 处方经验的数据很少。这项回顾性图表研究描述了一位家庭医生在私人诊所中对 71 名阿片类药物依赖患者使用 Suboxone 进行治疗的前 2 年临床经验。在直接观察快速办公室剂量诱导后，在有持续稳定证据的情况下每月开具 Suboxone 处方。定期进行尿液筛查，并将患者转介进行咨询和其他辅助服务。患者平均年龄为 32 岁，阿片类药物依赖持续时间为 4.3 年，主要为白人（93%）和有工作（70%）。52%的患者主要使用海洛因（大多数通过注射），70%的患者没有阿片类激动剂替代治疗史。近一半（47%）的患者自行支付治疗费用。剂量诱导期间的依从性非常好。Suboxone 维持剂量平均为 10 毫克（范围 2-24 毫克）/天。Suboxone 治疗开始后，超过 80%的尿液样本呈阿片类药物阴性，尽管尿液分析并不总是包括对羟考酮的检测。75%的患者通过继续 Suboxone 治疗（43%）、成功减少剂量（21%）、转至美沙酮维持治疗（7%）或住院治疗（4%）而获得成功。58%的患者报告接受了咨询。几乎所有（85%）患者都按时支付费用。未发现安全、药物滥用或药物转移问题。总体而言，基于办公室的 Suboxone 治疗易于实施，医生认为经验非常出色。Suboxone 维持治疗与良好的治疗保留率和显著减少阿片类药物使用相关，并有助于接触到包括注射吸毒者在内的患者，而这些患者没有阿片类激动剂替代治疗史。
