a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA.
b Perelman School of Medicine at the University of Pennsylvania , Philadelphia , Pennsylvania , USA.
Subst Abus. 2018;39(2):167-172. doi: 10.1080/08897077.2018.1443541. Epub 2018 May 4.
Syringe exchange programs are uniquely positioned to offer treatment services to interested clients. Prevention Point Philadelphia recently expanded to offer buprenorphine maintenance treatment through its Stabilization, Treatment, and Engagement Program (STEP).
To describe the STEP model of care and report treatment outcomes.
Retrospective chart review of patients enrolled in STEP (October 2011-August 2014). Our main outcome measure was time retained in treatment, defined as time from treatment initiation to treatment failure. Secondary outcome measures were buprenorphine and opiate use, from urine toxicology screens. We analyzed retention in treatment using Kaplan-Meier survival estimates; patients who remained in treatment at the end of the study period were censored on that day. For buprenorphine and opiate use, we calculated the percentage of patients who were positive for buprenorphine and opiates in each month of treatment.
Of the 124 patients enrolled in STEP, the median age was 41 (range 21 to 63) and 80% reported injection heroin use. Comorbidities were common: 33% had HIV infection, most reported anxiety (78%) or depression (71%), and 20% were homeless. The most common program outcomes were unplanned self-discharge (n = 29; 23%), incarceration (n = 20; 16%), and administrative discharge (n = 19; 15%). The percentage of patients retained in treatment at 3, 6, 9, and 12 months was 77%, 65%, 59%, and 56%, respectively. Among those retained, the percentage with a positive buprenorphine screen at 3, 6, 9, and 12 months was 88%, 100%, 96%, and 95%, respectively. The percentage with a positive opiates screen was 19%, 13%, 17%, and 16%, respectively.
With a program that blended organizational and community resources, retention in buprenorphine maintenance treatment was comparable to retention rates reported from other settings. Further research should directly compare treatment outcomes in syringe exchange program-based settings versus primary care and specialty settings.
注射器交换计划具有独特的优势，可以为有兴趣的客户提供治疗服务。费城预防点最近通过其稳定、治疗和参与计划（STEP）扩大了丁丙诺啡维持治疗的范围。
描述 STEP 治疗模式，并报告治疗结果。
对 2011 年 10 月至 2014 年 8 月期间参加 STEP 的患者进行回顾性图表审查。我们的主要观察指标是治疗保留时间，定义为从治疗开始到治疗失败的时间。次要观察指标是尿液毒理学检测到的丁丙诺啡和阿片类药物的使用情况。我们使用 Kaplan-Meier 生存估计分析治疗保留情况；在研究结束时仍在治疗中的患者在该日被删失。对于丁丙诺啡和阿片类药物的使用，我们计算了每个月使用丁丙诺啡和阿片类药物的患者比例。
在参加 STEP 的 124 名患者中，中位年龄为 41 岁（范围为 21 岁至 63 岁），80%报告注射海洛因。合并症很常见：33%感染 HIV，大多数报告焦虑（78%）或抑郁（71%），20%无家可归。最常见的项目结果是无计划的自行出院（n = 29；23%）、监禁（n = 20；16%）和行政出院（n = 19；15%）。治疗 3、6、9 和 12 个月时保留治疗的患者比例分别为 77%、65%、59%和 56%。在保留的患者中，3、6、9 和 12 个月时丁丙诺啡检测呈阳性的比例分别为 88%、100%、96%和 95%，阿片类药物检测呈阳性的比例分别为 19%、13%、17%和 16%。
通过结合组织和社区资源的项目，丁丙诺啡维持治疗的保留率与其他环境报告的保留率相当。应进一步开展研究，直接比较基于注射器交换计划的治疗环境与初级保健和专科治疗环境的治疗结果。
