Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, 17033-0850, Pennsylvania.
Am J Addict. 2017 Dec;26(8):859-863. doi: 10.1111/ajad.12644. Epub 2017 Nov 16.
Previous research has been inconclusive about whether opioid-dependent patients with psychiatric comorbidities have shorter treatment retention and higher relapse rates. This study aims to evaluate the impact of mental health comorbidities on adherence to buprenorphine using a large, national health insurance claims data base.
We used MarketScan® data from 2012 to 2014 to perform this analysis. Inclusion criteria included all patients with an opioid use disorder-related ICD-9 code who had been prescribed buprenorphine (n = 2947). Medication adherence was defined using the Medication Possession Ratio ≥.8 (MPR) and logistic regression was used to examine the association between medication adherence and mental health diagnoses, which included Alzheimer's/dementia, schizophrenia, other psychosis, major depressive disorder/bipolar disorder (MDDBP), anxiety disorder, personality disorder, and mental health disorder not elsewhere specified (NOS).
Of the 2947 patients included in our analysis, the most common diagnoses were anxiety disorder: n = 648 (22.0%), MDDBP: n = 467 (15.9%), and mental health disorder NOS: n = 959 (32.5%). Patients diagnosed with MDDBP were significantly less likely to adhere to opioid pharmacotherapy (OR = .805, 95%CI = .651, .994) than patients without MDDBP.
The presence of a psychiatric comorbidity can significantly affect adherence to buprenorphine. These trends illustrate the need for clinicians treating opioid use disorder with buprenorphine to screen for psychiatric disorders and monitor their medication adherence. There may also be opportunities to design interventions to help this vulnerable population adhere to buprenorphine and other forms of opioid pharmacotherapy. (Am J Addict 2017;26:859-863).
既往研究对于是否合并精神疾病的阿片类药物依赖患者的治疗保留率更低、复发率更高，结果并不一致。本研究旨在使用大型国家健康保险理赔数据库评估精神共病对丁丙诺啡依从性的影响。
我们使用 2012 年至 2014 年的 MarketScan®数据进行此项分析。纳入标准包括所有被诊断为阿片类药物使用障碍相关 ICD-9 编码并被处方丁丙诺啡的患者（n=2947）。使用药物持有率（MPR）≥.8 来定义药物依从性，使用 logistic 回归来检验药物依从性与精神疾病诊断之间的关系，这些诊断包括阿尔茨海默病/痴呆、精神分裂症、其他精神病、重性抑郁障碍/双相障碍（MDDBP）、焦虑症、人格障碍和未在他处特指的精神健康障碍。
在我们的分析中，纳入的 2947 例患者中最常见的诊断是焦虑症：n=648（22.0%）、MDDBP：n=467（15.9%）和精神健康障碍 NOS：n=959（32.5%）。与没有 MDDBP 的患者相比，被诊断为 MDDBP 的患者接受阿片类药物治疗的依从性显著降低（OR=0.805，95%CI=0.651，0.994）。
精神共病的存在可能会显著影响丁丙诺啡的依从性。这些趋势表明，用丁丙诺啡治疗阿片类药物使用障碍的临床医生需要筛查精神障碍并监测其药物依从性。可能还有机会设计干预措施，以帮助这一脆弱人群更好地依从丁丙诺啡和其他形式的阿片类药物治疗。（Am J Addict 2017；26：859-863）。
