Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, United States.
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.
J Subst Abuse Treat. 2017 Aug;79:12-19. doi: 10.1016/j.jsat.2017.05.010. Epub 2017 May 16.
Patients with opioid use disorder often require multiple treatment attempts before achieving stable recovery. Rates of disengagement from buprenorphine are highest in the first month of treatment and termination of buprenorphine therapy results in return to use rates as high as 90%. To better characterize these at-risk patients, this study aims to describe: 1) the frequency and characteristics of patients with very early disengagement (≤1month) from Office Based Opioid Treatment (OBOT) with buprenorphine and 2) the frequency and characteristics of patients who re-engage in care at this same OBOT clinic within 2years, among the subset of very early disengagers.
This is a retrospective cohort study of adult patients enrolled in a large urban OBOT program. Descriptive statistics were used to characterize the sample and the proportion of patients with very early (≤1month) disengagement and their re-engagement. Multivariable logistic regression models were used to identify patient characteristics associated with the outcomes of very early disengagement and re-engagement. Potential predictors included: sex, age, race/ethnicity, education, employment, opioid use history, prior substance use treatments, urine drug testing, and psychiatric diagnoses.
Overall, very early disengagement was unusual, with only 8.4% (104/1234) of patients disengaging within the first month. Among the subset of very early disengagers with 2years of follow-up, the proportion who re-engaged with this OBOT program in the subsequent 2years was 11.9% (10/84). Urine drug test positive for opiates within the first month (AOR: 2.01, 95% CI: 1.02-3.93) was associated with increased odds of very early disengagement. Transferring from another buprenorphine prescriber (AOR: 0.09, 95% CI: 0.01-0.70) was associated with decreased odds of very early disengagement. No characteristics were significantly associated with re-engagement.
Early disengagement is uncommon; however, continued opioid use appeared to be associated with higher odds of treatment disengagement and these patients may warrant additional support. Re-engagement was uncommon, suggesting the need for a more formal explicit system to encourage and facilitate re-engagement among patients who disengage.
患有阿片类药物使用障碍的患者通常需要多次尝试治疗才能稳定康复。在接受丁丙诺啡治疗的第一个月中，脱离治疗的比例最高，而终止丁丙诺啡治疗后，再次使用的比例高达 90%。为了更好地描述这些高危患者，本研究旨在描述：1）接受门诊阿片类药物治疗（OBOT）丁丙诺啡治疗的患者中，非常早期（≤1 个月）脱离治疗的频率和特征；2）在该非常早期脱离治疗亚组中，在同一 OBOT 诊所内，2 年内重新接受治疗的患者的频率和特征。
这是一项对参加大型城市 OBOT 计划的成年患者进行的回顾性队列研究。使用描述性统计数据来描述样本特征以及非常早期（≤1 个月）脱离治疗的患者比例及其重新接受治疗的比例。多变量逻辑回归模型用于确定与非常早期脱离治疗和重新接受治疗结局相关的患者特征。潜在的预测因素包括：性别、年龄、种族/民族、教育程度、就业状况、阿片类药物使用史、既往物质使用治疗、尿液药物检测和精神科诊断。
总体而言，非常早期脱离治疗的情况并不常见，只有 8.4%（104/1234）的患者在第一个月内脱离治疗。在有 2 年随访的非常早期脱离治疗亚组中，随后 2 年内有 11.9%（10/84）的患者重新在该 OBOT 诊所接受治疗。在第一个月内尿液阿片类药物检测阳性（OR：2.01，95%CI：1.02-3.93）与非常早期脱离治疗的可能性增加相关。从另一位丁丙诺啡处方医生转来（OR：0.09，95%CI：0.01-0.70）与非常早期脱离治疗的可能性降低相关。没有特征与重新接受治疗显著相关。
早期脱离治疗并不常见；然而，持续使用阿片类药物似乎与更高的治疗脱离可能性相关，这些患者可能需要额外的支持。重新接受治疗并不常见，这表明需要更正式的明确系统来鼓励和促进脱离治疗的患者重新接受治疗。
