Turner Lydia, Kruszewski Stefan P, Alexander G Caleb
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Addict. 2015 Jan;24(1):24-9. doi: 10.1111/ajad.12174.
Despite buprenorphine's promise as a novel therapy for opioid dependence, little is known about its clinical adoption. We characterized trends in ambulatory use of buprenorphine in the United States.
Cross-sectional, descriptive analyses of buprenorphine utilization from 2003 to 2013 using the IMS Health National Disease and Therapeutic Index, a nationally representative audit of ambulatory care. The primary unit of analysis was an office visit where buprenorphine was used for opioid dependence (treatment visit).
Between 2003 and 2013, there was significant uptake of buprenorphine in ambulatory treatment visits, from 0.16 million [M] (95% confidence interval [CI] 0.10-0.20) visits in 2003 to 2.1M (CI 1.9-2.3M) treatment visits during 2013. Approximately 90% involved the use of brand name combination buprenorphine/naloxone (Suboxone), although this percentage decreased modestly to 80% by the last quarter of 2013. Buprenorphine prescribing increased among all specialties, but the proportion accounted for by primary care physicians increased significantly from 6.0% in 2003 to 63.5% in 2013 and decreased among psychiatrists from 92.2% to 32.8% over the same time period.
The use of buprenorphine products to treat opioid dependence has increased significantly in the past 10 years and has shifted to greater use by primary care physicians, indicating a rapidly changing face of opioid maintenance therapy in the United States.
尽管丁丙诺啡有望成为治疗阿片类药物依赖的新型疗法，但对其临床应用情况却知之甚少。我们对美国丁丙诺啡门诊使用趋势进行了特征分析。
利用艾美仕市场研究公司的全国疾病与治疗指数，对2003年至2013年丁丙诺啡的使用情况进行横断面描述性分析，该指数是一项具有全国代表性的门诊医疗审计。主要分析单位是使用丁丙诺啡治疗阿片类药物依赖的门诊就诊（治疗就诊）。
2003年至2013年期间，门诊治疗就诊中丁丙诺啡的使用量显著增加，从2003年的16万次（95%置信区间[CI] 0.10 - 0.20）就诊增加到2013年的210万次（CI 1.9 - 2.3百万次）治疗就诊。约90%涉及使用丁丙诺啡/纳洛酮品牌复方制剂（舒倍生），不过到2013年最后一个季度，这一比例略有下降至80%。所有专科的丁丙诺啡处方量均有所增加，但初级保健医生所占比例从2003年的6.0%显著增至2013年的63.5%，同期精神科医生的比例则从92.2%降至32.8%。
在过去10年中，丁丙诺啡产品用于治疗阿片类药物依赖的情况显著增加，且已转向更多地由初级保健医生使用，这表明美国阿片类药物维持治疗的面貌正在迅速改变。
