同时使用丁丙诺啡进行阿片类药物使用障碍的药物辅助治疗和苯二氮䓬类药物：使用处方行为监测系统。
Concomitant use of buprenorphine for medication-assisted treatment of opioid use disorder and benzodiazepines: Using the prescription behavior surveillance system.
机构信息
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, HPNP Building, Rm 3334, P.O. Box 100496, Gainesville, FL, 32610, USA.
Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
出版信息
Drug Alcohol Depend. 2018 Jun 1;187:221-226. doi: 10.1016/j.drugalcdep.2018.02.019. Epub 2018 Apr 10.
BACKGROUND
Despite clinical guidelines discouraging the practice, it is well-documented that the concomitant use of benzodiazepines and opioid analgesics occurs regularly. Information on concomitant use of buprenorphine for medication-assisted treatment (MAT) of opioid use disorder (OUD) and benzodiazepines, however, is limited. Thus, we aimed to describe real-world drug dispensing patterns for the concomitant use of buprenorphine products approved for MAT and benzodiazepines.
METHODS
We examined concomitant use of buprenorphine for MAT and benzodiazepines using the 2013 Prescription Behavior Surveillance System data from eight states. For prescription-level analysis, we estimated the proportion of concomitant buprenorphine and benzodiazepine prescriptions and the proportions of concomitant prescriptions prescribed by the same provider (co-prescribing) and dispensed by the same pharmacy (co-dispensing) for each state. For patient-level analysis, we calculated the proportion of patients with ≥1 buprenorphine therapy episode overlapping with a benzodiazepine episode, i.e., concomitant users, and the proportion of concomitant users who experienced co-prescribing or co-dispensing.
RESULTS
In 2013, 1,925,072 prescriptions of buprenorphine products for MAT were dispensed to 190,907 patients in eight states. Approximately 1 in 8 buprenorphine prescriptions was used concomitantly with ≥1 benzodiazepine prescription(s). Co-prescribing proportions ranged from 22.2 to 64.6% across states, while co-dispensing proportions ranged from 54.7 to 91.0%. Approximately 17.7% of patients had >1 buprenorphine episode overlapping a benzodiazepine episode for ≥7 cumulative days' supply. Among these patients, 33.1-65.2% experienced co-prescribing, and 65.1-93.3% experienced co-dispensing.
CONCLUSIONS
The concomitant use of buprenorphine for MAT and benzodiazepines occurs frequently, with variations by state in co-prescribing and co-dispensing.
背景
尽管临床指南不鼓励这种做法，但有大量文献记录表明，苯二氮䓬类药物和阿片类镇痛药经常同时使用。然而，关于丁丙诺啡用于药物辅助治疗（MAT）治疗阿片类药物使用障碍（OUD）和苯二氮䓬类药物的同时使用的信息有限。因此，我们旨在描述同时使用丁丙诺啡产品治疗 MAT 和苯二氮䓬类药物的实际药物配药模式。
方法
我们使用来自八个州的 2013 年处方行为监测系统数据研究了丁丙诺啡用于 MAT 和苯二氮䓬类药物的同时使用情况。对于处方水平分析，我们估计了每个州同时使用的丁丙诺啡和苯二氮䓬类药物处方的比例，以及由同一提供者开具（共同开具）和由同一药房配药（共同配药）的同时处方的比例。对于患者水平分析，我们计算了至少有 1 次丁丙诺啡治疗期与苯二氮䓬类药物治疗期重叠（即同时使用）的患者比例，以及同时使用患者中共同开具或共同配药的比例。
结果
2013 年，在八个州共向 190907 名患者开出了 1925072 份丁丙诺啡 MAT 产品的处方。大约 1/8 的丁丙诺啡处方与至少 1 份苯二氮䓬类药物处方同时使用。各州的共同开具比例从 22.2%到 64.6%不等，而共同配药比例从 54.7%到 91.0%不等。大约 17.7%的患者有超过 1 次丁丙诺啡发作与苯二氮䓬类药物发作重叠，且累积供应天数超过 7 天。在这些患者中，33.1%-65.2%经历了共同开具处方，65.1%-93.3%经历了共同配药。
结论
丁丙诺啡用于 MAT 和苯二氮䓬类药物的同时使用非常普遍，各州在共同开具和共同配药方面存在差异。
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