Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington, CT, USA.
Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
Addiction. 2019 Nov;114(11):1992-1999. doi: 10.1111/add.14733. Epub 2019 Jul 25.
Opioid use disorder (OUD) remains a serious public health issue, and treating adults with OUD is a major priority in the United States. Little is known about trends in the diagnosis of OUD and in buprenorphine prescribing by physicians in office-based medical practices. We sought to characterize OUD diagnoses and buprenorphine prescribing among adults with OUD in the United States between 2006 and 2015.
We used a repeated cross-sectional design, based on data from the 2006-15 National Ambulatory Medical Care Surveys that surveyed nationally representative samples of office-based out-patient physician visits.
Adult patients aged 18 years or older with a diagnosis of OUD (n = 1034 unweighted) were included.
Buprenorphine prescribing was defined by whether visits involved buprenorphine or buprenorphine-naloxone, or not. We also examined other covariates (e.g. age, gender, race and psychiatric comorbidities).
We observed an almost tripling of the diagnosis of OUD from 0.14% in 2006-10 to 0.38% in 2011-15 in office-based medical practices (P < 0.001). Among adults diagnosed with OUD, buprenorphine prescribing increased from 56.1% in 2006-10 to 73.6% in 2011-15 (P = 0.126). Adults with OUD were less likely to receive buprenorphine prescriptions if they were Hispanic [adjusted odds ratio (aOR) = 0.26; 95% confidence interval (CI) = 0.11, 0.60], had Medicaid insurance (aOR = 0.27; 95% CI = 0.10, 0.74) or were diagnosed with other psychiatric disorders (aOR = 0.45; 95% CI = 0.25, 0.83) or substance use disorders (aOR = 0.19; 95% CI = 0.09, 0.41).
In office-based medical practices in the United States, diagnoses for opioid use disorder and buprenorphine prescriptions for adults with opioid use disorder increased from 0.14 and 56.1%, respectively, in 2006-10 to 0.38 and 73.6% in 2011-15.
阿片类药物使用障碍（OUD）仍然是一个严重的公共卫生问题，治疗 OUD 成年人是美国的首要任务。关于办公室医疗实践中 OUD 诊断和丁丙诺啡处方的趋势知之甚少。我们旨在描述美国 2006 年至 2015 年间 OUD 成年人的 OUD 诊断和丁丙诺啡处方情况。
我们使用了重复的横断面设计，基于 2006-15 年全国门诊医疗保健调查的数据，该调查对全国代表性的门诊医生就诊样本进行了调查。
包括年龄在 18 岁或以上的患有 OUD 诊断的成年患者（未经加权的 1034 例）。
丁丙诺啡处方的定义是就诊是否涉及丁丙诺啡或丁丙诺啡-纳洛酮，或者不涉及。我们还检查了其他协变量（例如年龄、性别、种族和精神合并症）。
我们观察到办公室医疗实践中 OUD 的诊断率从 2006-10 年的 0.14%几乎翻了三倍，达到 2011-15 年的 0.38%（P<0.001）。在被诊断患有 OUD 的成年人中，丁丙诺啡的处方从 2006-10 年的 56.1%增加到 2011-15 年的 73.6%（P=0.126）。如果患有 OUD 的成年人是西班牙裔[调整后的优势比（aOR）=0.26；95%置信区间（CI）=0.11,0.60]、有医疗补助保险（aOR=0.27；95%CI=0.10,0.74）或被诊断患有其他精神障碍（aOR=0.45；95%CI=0.25,0.83）或物质使用障碍（aOR=0.19；95%CI=0.09,0.41），则不太可能接受丁丙诺啡处方。
在美国的办公室医疗实践中，OUD 的诊断率和患有 OUD 的成年人的丁丙诺啡处方率分别从 2006-10 年的 0.14%和 56.1%上升到 2011-15 年的 0.38%和 73.6%。
