Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8030, USA.
Subst Abus. 2011 Oct;32(4):262-5. doi: 10.1080/08897077.2011.599256.
Physicians' adoption of buprenorphine/naloxone treatment is hindered by concerns over feasibility, cost, and lack of comfort treating patients with addiction. We examined the use of buprenorphine/naloxone in a community practice by two generalist physicians without addiction training, employing a retrospective chart review. From 2006-2010, 228 patients with opiate abuse/dependence were treated with buprenorphine/naloxone using a home-induction protocol. Multiple co-morbidities including diabetes (23% of patients), hypertension (36%), Hepatitis C (43%), and depression (74%) were concurrently managed. In this diverse sample, 1/228 experienced precipitated withdrawal during induction. Of the convenience subsample analyzed (n = 28), 82% (+/-10%) had negative urine drug tests for opioids; 92% (+/-11%) were negative for cocaine; 88% (+/-12%) were positive for buprenorphine. This case series demonstrated feasibility and safety of a low-cost buprenorphine/naloxone home induction protocol employed by generalists. Concurrent treatment of multiple comorbidities conforms with the patient-centered medical home ideal. Randomized trials of this promising approach are needed.
医生采用丁丙诺啡/纳洛酮治疗的主要顾虑是可行性、费用和缺乏治疗成瘾患者的经验。我们对两名没有成瘾治疗培训的全科医生在社区实践中的丁丙诺啡/纳洛酮使用情况进行了回顾性图表审查。2006 年至 2010 年，228 名阿片类药物滥用/依赖患者采用家庭诱导方案使用丁丙诺啡/纳洛酮治疗。同时还治疗了多种合并症，包括糖尿病（23%的患者）、高血压（36%）、丙型肝炎（43%）和抑郁症（74%）。在这个多样化的样本中，有 1/228 名患者在诱导过程中出现了戒断症状。对已分析的便利抽样（n = 28），82%（+/-10%）的患者尿液阿片类药物检测阴性；92%（+/-11%）可卡因检测阴性；88%（+/-12%）丁丙诺啡检测阳性。该病例系列证明了由全科医生实施的低成本丁丙诺啡/纳洛酮家庭诱导方案的可行性和安全性。同时治疗多种合并症符合以患者为中心的医疗之家的理想。需要对这种有前途的方法进行随机试验。
