Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
J Subst Abuse Treat. 2011 Dec;41(4):374-85. doi: 10.1016/j.jsat.2011.05.005. Epub 2011 Aug 6.
Despite evidence that buprenorphine is effective and safe and offers greater access as compared with methadone, implementation for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This study uses hierarchical linear modeling to examine National Treatment Center Study data to identify counselor characteristics (attitudes, training, and beliefs) and organizational factors (accreditation, caseload, access to buprenorphine, and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate-dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) was associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine.
尽管有证据表明丁丙诺啡有效且安全，并且与美沙酮相比，获得它的途径更多，但阿片类药物依赖的治疗实施仍然很薄弱。研究表明，法律和监管因素、州政策以及组织和提供者变量会影响丁丙诺啡的采用。本研究使用层次线性模型来检验国家治疗中心研究的数据，以确定影响丁丙诺啡用于治疗阿片类药物依赖的实施的咨询师特征（态度、培训和信念）和组织因素（认证、病例量、丁丙诺啡的可及性和其他基于证据的实践）。分析表明，关于丁丙诺啡的培训、阿片类药物依赖患者的更高患病率以及治疗计划对 12 步模型的重视程度较低，这预示着咨询师对丁丙诺啡的接受程度和对其有效性的看法更高。结果还表明，治疗计划将丁丙诺啡用于任何治疗目的（解毒、维持和/或疼痛管理）和时间（数据收集的日历年）与咨询师对丁丙诺啡的了解的传播增加以及对丁丙诺啡的更有利的态度有关。
