National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia.
Addiction. 2015 Apr;110(4):646-55. doi: 10.1111/add.12834.
To examine characteristics of first-time methadone and buprenorphine clients and factors associated with risk of leaving first treatment in New South Wales (NSW), Australia.
Retrospective linkage study of opioid substitution therapy (OST) treatment, court, custody and mortality data.
NSW, Australia.
First-time OST entrants (August 2001-December 2010).
Characteristics of clients were examined. Time-dependent Cox models examined factors associated with the risk of leaving first treatment, with demographic, criminographic and treatment variables jointly considered. Interactions between medication and other variables upon risk of leaving treatment were examined.
There were 15 600 treatment entrants: 7183 (46%) commenced buprenorphine, 8417 (54%) commenced methadone; the proportion entering buprenorphine increased over time. Those starting buprenorphine switched medications more frequently and had more subsequent treatment episodes. Buprenorphine retention was also poorer. On average, 44% spent 3+ months in treatment compared with 70% of those commencing methadone; however, buprenorphine retention for first-time entrants improved over time, whereas methadone retention did not. Multivariable Cox models indicated that in addition to sex, age, treatment setting and criminographic variables, the risk of leaving a first treatment episode was greater on any given day for those receiving buprenorphine, and was dependent on the year treatment was initiated. There was no interaction between any demographic variables and medication received, suggesting no clear evidence of any particular groups for whom each medication might be better suited in terms of improving retention.
Although retention rates for buprenorphine treatment have improved in New South Wales, Australia, individuals starting methadone treatment still show higher retention rates.
本研究旨在考察澳大利亚新南威尔士州（NSW）首次接受美沙酮和丁丙诺啡治疗的患者特征，以及与首次治疗脱落风险相关的因素。
本研究为回顾性的阿片类物质替代疗法（OST）治疗、法庭、监禁和死亡率数据的关联研究。
澳大利亚 NSW。
首次接受 OST 治疗的患者（2001 年 8 月至 2010 年 12 月）。
评估患者的特征。时间依赖性 Cox 模型检验与首次治疗脱落风险相关的因素，联合考虑人口统计学、犯罪学和治疗变量。检验药物与其他变量之间相互作用对治疗脱落风险的影响。
共有 15600 例治疗患者入组：7183 例（46%）开始使用丁丙诺啡，8417 例（54%）开始使用美沙酮；丁丙诺啡的使用比例随时间推移而增加。使用丁丙诺啡的患者更频繁地更换药物，并且有更多的后续治疗阶段。丁丙诺啡的保留率也较差。平均而言，44%的患者接受治疗 3 个月以上，而开始使用美沙酮的患者则有 70%；然而，首次入组的丁丙诺啡患者的保留率随时间推移而提高，而美沙酮保留率则没有。多变量 Cox 模型表明，除了性别、年龄、治疗环境和犯罪学变量外，对于每天接受丁丙诺啡治疗的患者，在任何给定日期离开第一个治疗阶段的风险更大，并且该风险取决于治疗开始的年份。没有任何人口统计学变量与所接受的药物之间存在交互作用，这表明没有明确的证据表明对于每种药物，对于改善保留率而言，有任何特定的群体更适合使用哪种药物。
尽管澳大利亚新南威尔士州丁丙诺啡治疗的保留率有所提高，但开始接受美沙酮治疗的个体仍显示出更高的保留率。
