Daubresse Matthew, Saloner Brendan, Pollack Harold A, Alexander G Caleb
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.
Addiction. 2017 Jun;112(6):1045-1053. doi: 10.1111/add.13762. Epub 2017 Feb 23.
Buprenorphine is commonly used to treat opioid use disorder; however, non-buprenorphine prescription opioid use among these patients is not well defined. We sought to estimate the prevalence of non-buprenorphine opioid use among incident buprenorphine users and quantify levels of opioid use prior to, during and after the first treatment episode.
We used QuintilesIMS anonymized, individual-level, all-payer pharmacy claims to identify incident users of buprenorphine between January 2010 and July 2012 from a large cohort of approximately 50 million patients filling two or more prescriptions for any opioid during any calendar year between 2006 and 2013 in 11 states of interest.
Eleven states within the United States.
Of the individuals who met our inclusion criteria (n = 38 096), 55% were female and half were aged between 29 and 54 years. Median length of the first treatment episode was 55 days [interquartile range (IQR) = 28-168 days].
We calculated four measures of non-buprenorphine opioid use: (1) number of prescriptions, (2) quantity dispensed, (3) days of supply and (4) total morphine milligram equivalents (MME) before, during and after the first treatment episode. Our primary outcome was the MME per opioid day supplied during each time period.
Approximately two-fifths (43%) of buprenorphine recipients filled an opioid prescription during the treatment episode and two-thirds (67%) filled an opioid prescription following treatment. The mean total of MME per opioid day supplied 12 months prior to treatment declined from 57 mg/per day [95% confidence interval (CI) = 57, 58] to 54 mg/per day (95% CI = 54, 55) during the treatment episode, then remained constant at 55 mg/per day (95% CI = 54, 56) following the treatment episode.
The use of buprenorphine for the treatment of opioid use disorder has increased markedly in the United States. However, a substantial proportion of patients fill prescriptions for non-buprenorphine opioids during and following such treatment.
丁丙诺啡常用于治疗阿片类药物使用障碍；然而，这些患者中非丁丙诺啡处方类阿片药物的使用情况尚不明确。我们试图估算初次使用丁丙诺啡的患者中非丁丙诺啡阿片类药物的使用 prevalence，并量化首次治疗期间及治疗前后的阿片类药物使用水平。
我们使用昆泰公司（QuintilesIMS）匿名的个人层面全支付方药房报销数据，从2006年至2013年期间在11个感兴趣的州每年开具两种或更多阿片类药物处方的约5000万患者的大群组中，识别出2010年1月至2012年7月期间初次使用丁丙诺啡的患者。
美国的11个州。
在符合我们纳入标准的个体（n = 38096）中，55%为女性，一半年龄在29至54岁之间。首次治疗疗程的中位时长为55天[四分位间距（IQR）= 28 - 168天]。
我们计算了非丁丙诺啡阿片类药物使用的四项指标：（1）处方数量，（2）配药量，（3）供应天数，以及（4）首次治疗疗程前、治疗期间和治疗后的总吗啡毫克当量（MME）。我们的主要结局是每个时间段内每天供应的阿片类药物的MME。
约五分之二（43%）的丁丙诺啡接受者在治疗期间开具了阿片类药物处方，三分之二（67%）在治疗后开具了阿片类药物处方。治疗前12个月每天供应的阿片类药物的平均总MME从57毫克/天[95%置信区间（CI）= 57, 58]降至治疗期间的54毫克/天（95% CI = 54, 55），然后在治疗后保持在55毫克/天（95% CI = 54, 56）。
在美国，丁丙诺啡用于治疗阿片类药物使用障碍的情况显著增加。然而，相当一部分患者在这种治疗期间及治疗后开具了非丁丙诺啡阿片类药物的处方。
