Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States.
Drug Alcohol Depend. 2020 Jul 1;212:108067. doi: 10.1016/j.drugalcdep.2020.108067. Epub 2020 May 15.
This study examines whether MOUD increases treatment completion and retention in both short-term (ST) and long-term (LT) residential programs using a national dataset.
Data were extracted from the 2015-2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay >10 days; LT: >90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics.
Only 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes.
Despite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program.
本研究使用全国性数据集，考察美沙酮维持治疗（MOUD）是否会提高短期（ST）和长期（LT）住院治疗项目中的治疗完成率和保留率。
从 2015-2017 年 TEDS-D（治疗期数据集-出院）阿片类药物使用成人 ST（n=87296）和 LT（n=66623）住院治疗数据集中提取数据。主要结局变量为治疗完成率和保留率（ST：住院时间>10 天；LT：>90 天）。逻辑回归分别估计了 MOUD 对 ST 和 LT 住院治疗的治疗完成率和保留率的影响，同时控制了个体背景特征。
只有 18%的住院治疗计划中的患者有 MOUD 治疗计划。对于 ST 住院治疗，MOUD 与治疗完成率增加 40%（OR=1.404）和保留率增加 34%（OR=1.337）相关。对于 LT 住院治疗，MOUD 与治疗完成率降低 26%（OR=0.743）和保留率无显著增加相关。事后分析表明，保险覆盖可能会影响结果。
尽管 MOUD 是 OUD 的标准治疗方法，但 MOUD 在住院治疗中的应用尤其不足。进一步的研究应集中在如何最好地将 MOUD 整合到短期住院治疗中，并探索 MOUD 在长期住院治疗项目中的潜在可行性。鉴于住院治疗后过量用药的风险，对于至少短期住院治疗项目而言，这种环境可能有利于在结构化治疗环境中整合心理社会治疗和早期 MOUD 参与，作为长期康复计划连续性护理的一部分。
