Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK (KML, JS, KJJ); University of Washington, 4333 Brooklyn Ave NE, Seattle, WA (MMG).
J Addict Med. 2021;15(4):297-302. doi: 10.1097/ADM.0000000000000757.
Opioid-related disparities are magnified among Alaska Native and American Indian (ANAI) people. Yet, no outcome studies on medication for addiction treatment, an effective treatment in other populations, among ANAI people exist. The objective of this study was to identify variables associated with buprenorphine/naloxone retention among ANAI people with opioid use disorder (OUD).
The sample was 240 ANAI adults in Anchorage, Alaska who received buprenorphine/naloxone treatment for an OUD. We gathered data from the electronic health record from January 1, 2015 to December 31, 2019. We used survival analysis to explore possible predictors (demographic variables, psychiatric comorbidity, medical severity, previous opioid prescriptions, previous injury, alcohol use disorder, and co-occurring substance use) of length of treatment retention (in days) while accounting for right censoring.
We found that 63% of the 240 patients were retained in buprenorphine/naloxone treatment at 90 days, 51% at 6 months, and 40% at 1 year, slightly lower than the general US population. Younger age (hazard ratio 1.69, 95% confidence intervals 1.17-2.45) and co-occurring substance use (hazard ratio 2.95, 95% confidence intervals 1.99-4.38) were associated with increased rate of buprenorphine/naloxone treatment discontinuation.
Younger patients and those with co-occurring substance use remain at higher risk of discontinuing buprenorphine/naloxone treatment for OUD in this population of ANAI people. Treatment programs serving ANAI people may consider paying special attention to patients with these characteristics to prevent treatment discontinuation. Our study highlights the need to address poly-substance use among ANAI people in treatment.
阿留申原住民和美洲印第安人（ANAI）人群中阿片类药物相关差异更为明显。然而，在 ANAI 人群中，针对药物治疗成瘾的结果研究（在其他人群中是一种有效的治疗方法）并不存在。本研究的目的是确定与接受阿片类药物使用障碍（OUD）治疗的 ANAI 人群中丁丙诺啡/纳洛酮保留相关的变量。
该样本是 240 名在阿拉斯加安克雷奇接受丁丙诺啡/纳洛酮治疗 OUD 的 ANAI 成年人。我们从 2015 年 1 月 1 日至 2019 年 12 月 31 日的电子健康记录中收集数据。我们使用生存分析来探索可能的预测因素（人口统计学变量、精神共病、医疗严重程度、以前的阿片类药物处方、以前的伤害、酒精使用障碍和共病物质使用），以解释右删失，从而预测治疗保留时间（以天为单位）的长短。
我们发现，240 名患者中有 63%在 90 天时保留在丁丙诺啡/纳洛酮治疗中，51%在 6 个月时保留，40%在 1 年时保留，略低于美国一般人群。年龄较小（危险比 1.69，95%置信区间 1.17-2.45）和共病物质使用（危险比 2.95，95%置信区间 1.99-4.38）与丁丙诺啡/纳洛酮治疗中断的风险增加相关。
在这一 ANAI 人群中，年轻患者和共病物质使用者在 OUD 中继续使用丁丙诺啡/纳洛酮治疗的风险更高。为 ANAI 人群提供服务的治疗项目可能需要特别注意这些特征的患者，以防止治疗中断。我们的研究强调了在治疗中解决 ANAI 人群中多物质使用问题的必要性。
