Department of Population Health, NYU School of Medicine, New York, NY, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Addiction. 2020 Sep;115(9):1683-1694. doi: 10.1111/add.14991. Epub 2020 Feb 24.
Evidence from randomized controlled trials establishes that medication treatment with methadone and buprenorphine reduces opioid use and improves treatment retention. However, little is known about the role of such medications compared with non-medication treatments in mitigating overdose risk among US patient populations receiving treatment in usual care settings. This study compared overdose mortality among those in medication versus non-medication treatments in specialty care settings.
Retrospective cohort study using state-wide treatment data linked to death records. Survival analysis was used to analyze data in a time-to-event framework.
Services delivered by 757 providers in publicly funded out-patient specialty treatment programs in Maryland, USA between 1 January 2015 and 31 December 2016.
A total of 48 274 adults admitted to out-patient specialty treatment programs in 2015-16 for primary diagnosis of opioid use disorder.
Main exposure was time in medication treatment (methadone/buprenorphine), time following medication treatment, time exposed to non-medication treatments and time following non-medication treatment. Main outcome was opioid overdose death during and after treatment. Hazard ratios were calculated using Cox proportional hazard regression. Propensity score weights were adjusted for patient information on sex, age, race, region of residence, marital and veteran status, employment, homelessness, primary opioid, mental health treatment, arrests and criminal justice referral.
The study population experienced 371 opioid overdose deaths. Periods in medication treatment were associated with substantially reduced hazard of opioid overdose death compared with periods in non-medication treatment [adjusted hazard ratio (aHR) = 0.18, 95% confidence interval (CI) = 0.08-0.40]. Periods after discharge from non-medication treatment (aHR = 5.45, 95% CI = 2.80-9.53) and medication treatment (aHR = 5.85, 95% CI = 3.10-11.02) had similar and substantially elevated risks compared with periods in non-medication treatments.
Among Maryland patients in specialty opioid treatment, periods in treatment are protective against overdose compared with periods out of care. Methadone and buprenorphine are associated with significantly lower overdose death compared with non-medication treatments during care but not after treatment is discontinued.
随机对照试验的证据表明，美沙酮和丁丙诺啡的药物治疗可减少阿片类药物的使用并提高治疗保留率。然而，在美国患者在常规护理环境中接受治疗的情况下，与非药物治疗相比，此类药物在减轻过量风险方面的作用知之甚少。本研究比较了药物治疗与专科护理环境中的非药物治疗之间的药物治疗患者的过量死亡率。
使用全州范围内的治疗数据与死亡记录相关联的回顾性队列研究。生存分析用于在时间事件框架中分析数据。
在美国马里兰州，2015 年 1 月 1 日至 2016 年 12 月 31 日期间，由 757 名提供者在公共资助的门诊专科治疗计划中提供服务。
2015-16 年共 48274 名成年人因原发性阿片类药物使用障碍入院接受门诊专科治疗。
主要暴露是药物治疗（美沙酮/丁丙诺啡）时间、药物治疗后时间、非药物治疗暴露时间和非药物治疗后时间。主要结果是治疗期间和治疗后的阿片类药物过量死亡。使用 Cox 比例风险回归计算风险比。根据患者的性别、年龄、种族、居住地区、婚姻和退伍军人身份、就业状况、无家可归、主要阿片类药物、心理健康治疗、逮捕和刑事司法转介等信息，调整了患者信息的倾向评分权重。
研究人群中有 371 例阿片类药物过量死亡。与非药物治疗期间相比，药物治疗期间的阿片类药物过量死亡风险显著降低（调整后的危险比[aHR] = 0.18，95%置信区间[CI] = 0.08-0.40）。与非药物治疗期间相比，非药物治疗后时期（aHR = 5.45，95%CI = 2.80-9.53）和药物治疗后时期（aHR = 5.85，95%CI = 3.10-11.02）的风险相似且显著升高。
在马里兰州的专科阿片类药物治疗患者中，与护理期间相比，治疗期间的药物治疗可预防过量。与非药物治疗相比，美沙酮和丁丙诺啡在治疗期间与显著降低的过量死亡相关，但在停止治疗后则没有。
