From the Albert Einstein College of Medicine (COC, RJR, JLS, AG) and Montefiore Medical Center (COC, RJR, JLS, AG), Bronx; and Sophie Davis School of Biomedical Education (NLS), City College of the City University of New York, NY.
J Addict Med. 2013 Jul-Aug;7(4):287-93. doi: 10.1097/ADM.0b013e31829727b2.
As buprenorphine treatment and illicit buprenorphine use increase, many patients seeking buprenorphine treatment will have had prior experience with buprenorphine. Little evidence is available to guide optimal treatment strategies for patients with prior buprenorphine experience. We examined whether prior buprenorphine experience was associated with treatment retention and opioid use. We also explored whether type of prior buprenorphine use (prescribed or illicit use) was associated with these treatment outcomes.
We analyzed interview and medical record data from a longitudinal cohort study of 87 individuals who initiated office-based buprenorphine treatment. We examined associations between prior buprenorphine experience and 6-month treatment retention using logistic regression models, and prior buprenorphine experience and any self-reported opioid use at 1, 3, and 6 months using nonlinear mixed models.
Most (57.4%) participants reported prior buprenorphine experience; of these, 40% used prescribed buprenorphine and 60% illicit buprenorphine only. Compared with buprenorphine-naïve participants, those with prior buprenorphine experience had better treatment retention (adjusted odds ratio [AOR] = 2.65, 95% CI = 1.05-6.70). Similar associations that did not reach significance were found when exploring prescribed and illicit buprenorphine use. There was no difference in opioid use when comparing participants with prior buprenorphine experience with those who were buprenorphine-naive (AOR = 1.33, 95% CI = 0.38-4.65). Although not significant, qualitatively different results were found when exploring opioid use by type of prior buprenorphine use (prescribed buprenorphine vs buprenorphine-naïve, AOR = 2.20, 95% CI = 0.58-8.26; illicit buprenorphine vs buprenorphine-naïve, AOR = 0.47, 95% CI = 0.07-3.46).
Prior buprenorphine experience was common and associated with better retention. Understanding how prior buprenorphine experience affects treatment outcomes has important clinical and public health implications.
随着丁丙诺啡治疗和非法丁丙诺啡使用的增加，许多寻求丁丙诺啡治疗的患者之前都有过丁丙诺啡治疗的经历。目前几乎没有证据可以指导有丁丙诺啡治疗经验的患者的最佳治疗策略。我们研究了之前是否有丁丙诺啡使用经验与治疗保留和阿片类药物使用有关。我们还探讨了之前丁丙诺啡使用的类型（处方或非法使用）是否与这些治疗结果有关。
我们分析了 87 名开始门诊丁丙诺啡治疗的纵向队列研究的访谈和病历数据。我们使用逻辑回归模型检验了先前丁丙诺啡经验与 6 个月治疗保留之间的关系，并使用非线性混合模型检验了先前丁丙诺啡经验与 1、3 和 6 个月任何自我报告的阿片类药物使用之间的关系。
大多数（57.4%）参与者报告了先前有丁丙诺啡使用经验；其中，40%使用过处方丁丙诺啡，60%仅使用过非法丁丙诺啡。与丁丙诺啡无经验的参与者相比，有丁丙诺啡使用经验的参与者治疗保留率更好（调整后的优势比[OR]为 2.65，95%置信区间[CI]为 1.05-6.70）。当探索处方和非法丁丙诺啡使用时，也发现了相似但未达到显著意义的关联。与丁丙诺啡无经验的参与者相比，有丁丙诺啡使用经验的参与者阿片类药物使用没有差异（OR=1.33，95%CI=0.38-4.65）。虽然没有达到显著意义，但当按先前丁丙诺啡使用类型（处方丁丙诺啡与丁丙诺啡无经验，OR=2.20，95%CI=0.58-8.26；非法丁丙诺啡与丁丙诺啡无经验，OR=0.47，95%CI=0.07-3.46）探索阿片类药物使用时，得到了定性不同的结果。
之前有丁丙诺啡使用经验很常见，与保留治疗有关。了解之前的丁丙诺啡使用经验如何影响治疗结果具有重要的临床和公共卫生意义。
