Larance Briony, Dietze Paul, Ali Robert, Lintzeris Nicholas, White Nancy, Jenkinson Rebecca, Degenhardt Louisa
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia.
Drug Alcohol Rev. 2015 Nov;34(6):603-10. doi: 10.1111/dar.12277. Epub 2015 May 6.
Buprenorphine-naloxone (BNX) film for opioid dependence treatment was introduced in Australia in 2011. A key difference in State policy approaches saw transfer from BNX tablets to BNX film mandated in South Australia (SA) with New South Wales (NSW) and Victoria (VIC) having less stringent policies. This study examined (i) how initiations and transfers were implemented, (ii) the profile and predictors of adverse effects as self-reported by BNX film clients, and (iii) dosing issues.
Survey of 334 buprenorphine (BPN), BNX tablet and BNX film clients and semi-structured interviews with 39 key experts (KEs) in 2012. Comparisons are made between clients interviewed in SA versus NSW and VIC combined.
Among the 180 current BNX film clients, 23% started treatment on BNX film, 18% requested a transfer to BNX film and 59% (n = 106) reported their clinic/prescriber recommended transfer to BNX film. Among clients who were offered but refused a transfer to BNX film (n = 66), the most common reason was 'I am happy with my current treatment and do not see a reason to change' (53%). Some opioid substitution therapy clients and KE viewed transfers as 'forced' (i.e. no choice of buprenorphine formulation). Multivariable regression showed residing in SA (vs. NSW/VIC) and a shorter length of current treatment episode were associated with more BNX film-attributed adverse effects but clinic/prescriber-recommended transfer was not.
The introduction of BNX film in Australia varied across States. A perception of restricted choice in medication may have undermined initial acceptance in SA.
用于治疗阿片类药物依赖的丁丙诺啡 - 纳洛酮（BNX）薄膜片于2011年在澳大利亚推出。各州政策方法的一个关键差异在于，南澳大利亚州（SA）规定从BNX片剂转为使用BNX薄膜片，而新南威尔士州（NSW）和维多利亚州（VIC）的政策则没那么严格。本研究调查了：（i）初始治疗和转换治疗是如何实施的；（ii）BNX薄膜片使用者自我报告的不良反应特征及预测因素；（iii）给药问题。
2012年对334名丁丙诺啡（BPN）使用者、BNX片剂使用者和BNX薄膜片使用者进行了调查，并对39名关键专家（KEs）进行了半结构化访谈。对在南澳大利亚州接受访谈的使用者与新南威尔士州和维多利亚州合并后的使用者进行了比较。
在180名当前使用BNX薄膜片的使用者中，23%开始使用BNX薄膜片进行治疗，18%要求转用BNX薄膜片，59%（n = 106）报告其诊所/开处方者建议转用BNX薄膜片。在那些被提供转用BNX薄膜片但拒绝的使用者（n = 66）中，最常见的原因是“我对目前的治疗满意，没有理由改变”（53%）。一些阿片类药物替代疗法使用者和关键专家认为转换是“被迫的”（即没有丁丙诺啡剂型的选择）。多变量回归显示，居住在南澳大利亚州（与新南威尔士州/维多利亚州相比）以及当前治疗疗程较短与更多归因于BNX薄膜片的不良反应相关，但诊所/开处方者建议的转换则不然。
BNX薄膜片在澳大利亚各州的引入情况各不相同。对药物选择受限的认知可能削弱了南澳大利亚州对其的初步接受度。
