Vermont Center for Behavior and Health, Lerner School of Medicine, University of Vermont, 1 South Prospect Street, Burlington, VT, United States of America; Integrated Substance Abuse Programs, Geffen School of Medicine, University of California at Los Angeles, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, United States of America.
Integrated Substance Abuse Programs, Geffen School of Medicine, University of California at Los Angeles, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, United States of America.
J Subst Abuse Treat. 2019 Feb;97:84-90. doi: 10.1016/j.jsat.2018.11.003. Epub 2018 Nov 19.
Opioid overdose deaths in the United States have risen dramatically in the past decade. In response to this public health crisis, Vermont created an innovative system called the "hub-and-spoke" (H & S) system, initiated in January 2013. The H & S system has 7 regional "hubs" that offer methadone and buprenorphine, as well as intensive support, and 77 local "spokes" (primary care settings) that offer buprenorphine (and naltrexone to a much lesser extent). Questionnaires were administered to 80 participants in the H & S system (stratified by geographic region, treatment site, and gender) and 20 participants with opioid use disorder not currently in treatment. Data included demographics, drug and alcohol use; opioid use; injection use; education/employment; criminal justice involvement; family and relationship functioning; health and healthcare utilization; multiple areas of mental health functioning; opioid overdose; satisfaction with life areas; stigma; and perceived treatment effectiveness. In-treatment group participants reported use and functioning for the 90 days prior to the date of the interview (T) and, retrospectively, a comparable 90-day period prior to treatment entry (T). Out-of-treatment group participants were queried about functioning at the time of the interview (T) and 12 months earlier (T). Individuals not in treatment showed no meaningful changes in any domain from T to T. Conversely, participants currently in treatment in the H & S system showed large reductions in substance use, overdoses, emergency department visits, police contacts, and family conflict, and improvements in mood and satisfaction with all areas of life, except work/school participation. Additionally, 85% of in-treatment participants reported 90-day abstinence from opioid use compared to 0% of out-of-treatment participants at T. These findings illustrate that medication for opioid use disorders, as delivered in the H & S system in Vermont, is highly effective for reducing opioid use and overdose and improving functioning in many life domains.
美国阿片类药物过量死亡人数在过去十年中急剧上升。为应对这一公共卫生危机，佛蒙特州于 2013 年 1 月创建了一个名为“中心辐射”（H & S）的创新系统。该 H & S 系统有 7 个区域“中心”，提供美沙酮和丁丙诺啡以及强化支持，以及 77 个当地“辐条”（初级保健场所），提供丁丙诺啡（纳曲酮的程度要小得多）。向 H & S 系统中的 80 名参与者（按地理区域、治疗地点和性别分层）和 20 名目前未接受治疗的阿片类药物使用障碍参与者发放了问卷。数据包括人口统计学信息、药物和酒精使用情况、阿片类药物使用情况、注射使用情况、教育/就业情况、刑事司法参与情况、家庭和关系功能、健康和医疗保健利用情况、多个心理健康功能领域、阿片类药物过量情况、生活满意度领域、耻辱感和对治疗效果的感知。治疗组参与者报告了在访谈日期（T）前 90 天的用药和功能情况，并回顾性地报告了治疗前 90 天的类似情况（T）。非治疗组参与者在访谈时（T）和 12 个月前（T）被问及功能情况。未接受治疗的个体在 T 到 T 期间在任何领域均无明显变化。相反，目前正在 H & S 系统中接受治疗的参与者在物质使用、过量用药、急诊就诊、警察接触和家庭冲突方面有很大减少，情绪和对生活各个方面的满意度也有所提高，除了工作/学业参与度。此外，85%的治疗组参与者报告在 T 时 90 天内戒除阿片类药物使用，而 T 时非治疗组参与者为 0%。这些发现表明，佛蒙特州 H & S 系统提供的治疗阿片类药物使用障碍的药物在减少阿片类药物使用和过量用药以及改善许多生活领域的功能方面非常有效。
