Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA.
Am J Addict. 2013 Jul-Aug;22(4):352-7. doi: 10.1111/j.1521-0391.2013.12032.x.
National treatment guidelines state that polysubstance users, including cocaine users, may not be appropriate candidates for office-based buprenorphine treatment. However, data to support this recommendation are sparse and conflicting, and the implications of this recommendation may include limiting the usefulness of buprenorphine treatment, as cocaine use is common among opioid-dependent individuals seeking buprenorphine treatment. We compared buprenorphine treatment outcomes (6-month treatment retention and self-reported opioid use over 6 months) in opioid-dependent cocaine users versus non-users who initiated buprenorphine treatment at an urban community health center.
We followed 87 participants over 6 months, collecting interview and medical record data. We used logistic regression models to test whether baseline cocaine use was associated with treatment retention and mixed effects nonlinear models to test whether baseline cocaine use was associated with self-reported opioid use.
At baseline, 39.1% reported cocaine use. In all participants, self-reported opioid use decreased from 89.7% to 27.4% over 6 months, and 6-month treatment retention was 54.5%. We found no significant difference in 6-month treatment retention (AOR = 1.56, 95% CI: .58-4.17, p = .38) or self-reported opioid use (AOR = .89, 95% CI: .26-3.07, p = .85) between cocaine users and non-users.
This study demonstrates that buprenorphine treatment retention is not worse in cocaine users than non-users, with clinically meaningful improvements in self-reported opioid use. These findings suggest that opioid-dependent cocaine users attain considerable benefits from office-based buprenorphine treatment and argue for the inclusion of these patients in office-based buprenorphine treatment programs.
国家治疗指南指出，包括可卡因使用者在内的多种药物使用者可能不适合接受门诊丁丙诺啡治疗。然而，支持这一建议的数据很少且相互矛盾，而且这一建议可能包括限制丁丙诺啡治疗的有效性，因为可卡因是寻求丁丙诺啡治疗的阿片类药物依赖者中常见的药物。我们比较了在城市社区卫生中心接受丁丙诺啡治疗的阿片类药物依赖可卡因使用者与非使用者的治疗结果（6 个月的治疗保留率和 6 个月期间自我报告的阿片类药物使用情况）。
我们对 87 名参与者进行了 6 个月的随访，收集了访谈和病历数据。我们使用逻辑回归模型来检验基线可卡因使用是否与治疗保留率相关，使用混合效应非线性模型来检验基线可卡因使用是否与自我报告的阿片类药物使用相关。
在基线时，39.1%的参与者报告使用可卡因。在所有参与者中，自我报告的阿片类药物使用从 89.7%下降到 6 个月时的 27.4%，6 个月的治疗保留率为 54.5%。我们发现，在 6 个月的治疗保留率（AOR=1.56，95%CI：.58-4.17，p=.38）或自我报告的阿片类药物使用（AOR=0.89，95%CI：.26-3.07，p=.85）方面，可卡因使用者和非使用者之间没有显著差异。
本研究表明，与非使用者相比，可卡因使用者的丁丙诺啡治疗保留率并不差，自我报告的阿片类药物使用有显著改善。这些发现表明，阿片类药物依赖可卡因使用者从门诊丁丙诺啡治疗中获得了相当大的益处，并支持将这些患者纳入门诊丁丙诺啡治疗项目。
