丁丙诺啡在门诊阿片类药物治疗中的长期维持治疗
Long-term retention in Office Based Opioid Treatment with buprenorphine.
作者信息
Weinstein Zoe M, Kim Hyunjoong W, Cheng Debbie M, Quinn Emily, Hui David, Labelle Colleen T, Drainoni Mari-Lynn, Bachman Sara S, Samet Jeffrey H
机构信息
Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States.
Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, United States.
出版信息
J Subst Abuse Treat. 2017 Mar;74:65-70. doi: 10.1016/j.jsat.2016.12.010. Epub 2016 Dec 30.
BACKGROUND
Guidelines recommend long-term treatment for opioid use disorder with buprenorphine; however, little is known about patients in long-term treatment. The aim of this study is to examine the prevalence and patient characteristics of long-term treatment retention (≥1year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine.
METHODS
This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014 in a large urban safety-net primary care OBOT program. The primary outcome was retention in OBOT for at least one continuous year. Potential predictors included age, race, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1year OBOT retention were identified using generalized estimating equation logistic regression models. Patients who re-enrolled in the program contributed repeated observations.
RESULTS
There were 1605 OBOT treatment periods among 1237 patients in this study. Almost half, 45% (717/1605), of all treatment periods were ≥1year and a majority, 53.7% (664/1237), of patients had at least one ≥1year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10year increase [1.05, 1.34]) were associated with greater odds of ≥1year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]) were associated with lower odds of ≥1year retention.
CONCLUSIONS
Over half of patients who presented to Office Based Opioid Treatment with buprenorphine were ultimately successfully retained for ≥1year. However, significant disparities in one-year treatment retention were observed, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C.
背景
指南推荐使用丁丙诺啡对阿片类药物使用障碍进行长期治疗；然而，对于接受长期治疗的患者了解甚少。本研究的目的是调查在一个使用丁丙诺啡的门诊阿片类药物治疗（OBOT）项目中，长期治疗留存（≥1年）的患病率及患者特征。
方法
这是一项对2002年1月至2014年2月期间在一个大型城市安全网初级保健OBOT项目中接受丁丙诺啡治疗的成年人进行的回顾性队列研究。主要结局是在OBOT中持续留存至少一年。潜在预测因素包括年龄、种族、精神疾病诊断、丙型肝炎、就业情况、既往丁丙诺啡使用情况、曾经使用海洛因情况、目前使用可卡因、苯二氮䓬类药物及酒精情况（入组时）。使用广义估计方程逻辑回归模型确定与≥1年OBOT留存相关的因素。重新加入该项目的患者提供重复观察数据。
结果
本研究中1237例患者有1605个OBOT治疗周期。所有治疗周期中近一半（45%，717/1605）≥1年，且大多数患者（53.7%，664/1237）至少有一个≥1年的周期。在调整分析中，女性（调整优势比[AOR]1.55，95%置信区间[CI][1.20, 2.00]）、精神疾病诊断（AOR 1.75[1.35, 2.27]）和年龄（每增加10岁AOR 1.19[1.05, 1.34]）与≥1年留存的较高几率相关。失业（AOR 0.72[0.56, 0.92]）、丙型肝炎（AOR 0.59[0.45, 0.76]）、黑人种族/族裔（AOR 0.53[0.36, 0.78]）和西班牙裔种族/族裔（AOR 0.66[0.48, 0.92]）与≥1年留存的较低几率相关。
结论
超过一半到门诊接受丁丙诺啡阿片类药物治疗的患者最终成功留存≥1年。然而，观察到在一年治疗留存方面存在显著差异，包括年轻、黑人、西班牙裔、失业或患有丙型肝炎的患者留存情况较差。
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