美国接受公共资金资助的阿片类药物使用障碍治疗项目的孕妇接受药物治疗的趋势和差异。
Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States.
机构信息
Department of Obstetrics and Gynecology, Thomas Jefferson University, 1233 Locust St. Suite 401, Philadelphia, PA 19107, USA.
Department of Obstetrics and Gynecology, Thomas Jefferson University, 1233 Locust St. Suite 401, Philadelphia, PA 19107, USA; Department of Psychiatry and Human Behavior, Thomas Jefferson University, 1233 Locust St. Suite 401, Philadelphia, PA 19107, USA.
出版信息
J Subst Abuse Treat. 2018 Jun;89:67-74. doi: 10.1016/j.jsat.2018.04.003. Epub 2018 Apr 6.
OBJECTIVE
To describe differences in geographic, demographic, treatment, and substance use characteristics by pharmacotherapy receipt among pregnant women entering publically funded treatment for opioid use disorder (OUD) in the United States.
METHODS
1996 to 2014 Treatment Episode Data Set-Admissions data from pregnant admissions with OUD, defined as reporting opioids as the primary substance of use leading to the treatment episode, were analyzed for this cross-sectional study. The proportion of all pregnant admissions with OUD who received pharmacotherapy was calculated by year and U.S. census region. Trends across time were assessed using the Cochrane-Armitage Trend test. Associations between demographic, substance use, and treatment characteristics and pharmacotherapy receipt were assessed using Chi-square tests and multivariable logistic regression.
RESULTS
The proportion of pregnant admissions where opioids were the primary substance of use increased from 16.9% to 41.6% during the study period, while the proportion of pregnant admissions with OUD who received pharmacotherapy remained relatively unchanged at around 50%. Overall, pharmacotherapy recipients were generally older and white, more likely to receive treatment in an outpatient setting, be self-referred, and report heroin as the primary substance, daily substance use, and intravenous drug use, and less likely to have a co-occurring psychiatric problem compared to those who did not receive pharmacotherapy. Regional differences in pharmacotherapy utilization exist; the South consistently had the fewest pregnant admissions with OUD receiving pharmacotherapy.
CONCLUSION
Although the proportion of pregnant admissions to substance use treatment centers with OUD has increased since the mid-1990s, the proportion receiving pharmacotherapy has not changed. Significant variations in pharmacotherapy utilization exist by geography and demographic, substance use and treatment characteristics. Utilization of pharmacotherapy at publically funded treatment centers providing care for pregnant women with OUD should be expanded.
目的
描述美国接受公共资金治疗的阿片类药物使用障碍（OUD）孕妇在接受药物治疗方面的地理位置、人口统计学、治疗和物质使用特征的差异。
方法
本横断面研究分析了 1996 年至 2014 年治疗期数据集中 OUD 孕妇的入院数据，这些孕妇的治疗期是由报告阿片类药物为主要使用物质引起的。按年和美国人口普查区域计算所有 OUD 孕妇中接受药物治疗的比例。使用 Cochrane-Armitage 趋势检验评估随时间的趋势。使用卡方检验和多变量逻辑回归评估人口统计学、物质使用和治疗特征与药物治疗接受之间的关联。
结果
在研究期间，报告阿片类药物为主要使用物质的孕妇入院比例从 16.9%增加到 41.6%，而 OUD 孕妇中接受药物治疗的比例相对不变，约为 50%。总体而言，药物治疗的接受者通常年龄较大且为白人，更有可能在门诊环境中接受治疗、自行转诊、报告海洛因为主要物质，每天使用物质和静脉注射药物，并且与未接受药物治疗的患者相比，更不可能存在共患精神问题。药物治疗利用存在地区差异；南部地区接受 OUD 治疗的孕妇入院人数最少。
结论
尽管自 20 世纪 90 年代中期以来，接受物质使用治疗中心 OUD 治疗的孕妇比例有所增加，但接受药物治疗的比例并未改变。药物治疗的利用在地理位置和人口统计学、物质使用和治疗特征方面存在显著差异。应扩大公共资金治疗中心为患有 OUD 的孕妇提供的药物治疗的利用。
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