Aletraris Lydia, Bond Edmond Mary, Roman Paul M
Owens Institute for Behavioral Research, University of Georgia, Athens, Georgia.
J Stud Alcohol Drugs. 2015 Jan;76(1):143-51.
Medication-assisted treatment for substance use disorders (SUDs) is not widely used in treatment programs. The aims of the current study were to document the prevalence of adoption and implementation of extended-release injectable naltrexone, the newest U.S. Food and Drug Administration-approved medication for alcohol use disorder (AUD), in U.S. treatment programs and to examine associations between organizational and patient characteristics and adoption.
The study used interview data from a nationally representative sample of 307 U.S. SUD treatment programs to examine adoption and implementation of injectable naltrexone.
Thirteen percent of programs used injectable naltrexone for AUD, and 3% of programs used it for opioid use disorder. Every treatment program that offered injectable naltrexone to its patients used it in conjunction with psychosocial treatment, particularly cognitive behavioral therapy. Multivariate logistic regression results indicated that adoption was positively associated with the provision of wraparound services, the percentage of privately insured patients, and the presence of inpatient detoxification services. For-profit status and offering inpatient services were negatively associated with adoption. Within adopting programs, an average of 4.1% of AUD patients and 7.1% of patients with opioid use disorder were currently receiving the medication, despite clinical directors' reports of positive patient outcomes, particularly for relapsers and for those who had been noncompliant with other medications. Cost was a significant issue for the majority of adopting organizations.
The rate of adoption of injectable naltrexone in U.S. treatment programs remains limited. Researchers should continue to examine patient, organizational, and external characteristics associated with the adoption and implementation of injectable naltrexone over time.
药物辅助治疗物质使用障碍（SUDs）在治疗项目中并未得到广泛应用。本研究的目的是记录美国治疗项目中缓释注射用纳曲酮（美国食品药品监督管理局最新批准用于治疗酒精使用障碍（AUD）的药物）的采用和实施情况，并研究组织和患者特征与采用情况之间的关联。
本研究使用了来自美国307个具有全国代表性的SUD治疗项目样本的访谈数据，以考察注射用纳曲酮的采用和实施情况。
13%的项目使用注射用纳曲酮治疗AUD，3%的项目使用它治疗阿片类物质使用障碍。每个向患者提供注射用纳曲酮的治疗项目都将其与心理社会治疗相结合使用，尤其是认知行为疗法。多变量逻辑回归结果表明，采用情况与提供全方位服务、私人保险患者的比例以及存在住院戒毒服务呈正相关。营利性状态和提供住院服务与采用情况呈负相关。在采用该药物的项目中，尽管临床主任报告患者预后良好，尤其是对于复发者和那些不依从其他药物治疗的患者，但目前平均只有4.1%的AUD患者和7.1%的阿片类物质使用障碍患者正在接受该药物治疗。成本是大多数采用该药物的机构面临的一个重要问题。
美国治疗项目中注射用纳曲酮的采用率仍然有限。研究人员应继续研究与注射用纳曲酮的采用和实施相关的患者、组织和外部特征。
