Department of Psychiatry, University of Iowa, Iowa City, IA, USA.
Department of Family Medicine, University of Iowa, Iowa City, IA, USA.
Subst Abuse Treat Prev Policy. 2021 Jan 12;16(1):8. doi: 10.1186/s13011-021-00342-5.
Opioid use disorder (OUD), a chronic disease, is a major public health problem. Despite availability of effective treatment, too few people receive it and treatment retention is low. Understanding barriers and facilitators of treatment access and retention is needed to improve outcomes for people with OUD.
To assess 3-month outcomes pilot data from a patient-centered OUD treatment program in Iowa, USA, that utilized flexible treatment requirements and prioritized engagement over compliance.
Forty patients (62.5% female: mean age was 35.7 years, SD 9.5) receiving medication, either buprenorphine or naltrexone, to treat OUD were enrolled in an observational study. Patients could select or decline case management, counseling, and peer recovery groups. Substance use, risk and protective factors, and recovery capital were measured at intake and 3 months.
Most participants reported increased recovery capital. The median Assessment of Recovery Capital (ARC) score went from 37 at enrollment to 43 (p < 0.01). Illegal drug use decreased, with the median days using illegal drugs in the past month dropping from 10 to 0 (p < 0.001). Cravings improved: 29.2% reported no cravings at intake and 58.3% reported no cravings at 3 months (p < 0.001). Retention rate was 92.5% at 3 months. Retention rate for participants who were not on probation/parole was higher (96.9%) than for those on probation/parole (62.5%, p = 0.021).
This study shows preliminary evidence that a care model based on easy and flexible access and strategies to improve treatment retention improves recovery capital, reduces illegal drug use and cravings, and retains people in treatment.
阿片类药物使用障碍（OUD）是一种慢性疾病，是一个主要的公共卫生问题。尽管有有效的治疗方法，但接受治疗的人数仍然很少，治疗的保留率也很低。为了改善 OUD 患者的治疗效果，需要了解治疗的获取和保留的障碍和促进因素。
评估美国爱荷华州一个以患者为中心的 OUD 治疗项目的 3 个月试点数据，该项目采用灵活的治疗要求，并优先考虑参与度而非依从性。
40 名（62.5%为女性：平均年龄 35.7 岁，标准差 9.5）接受药物治疗（丁丙诺啡或纳曲酮）治疗 OUD 的患者参与了一项观察性研究。患者可以选择或拒绝接受个案管理、咨询和同伴康复小组。在入组时和 3 个月时测量药物使用、风险和保护因素以及康复资本。
大多数参与者报告康复资本增加。评估康复资本（ARC）的中位数评分从入组时的 37 分提高到 43 分（p<0.01）。非法药物使用减少，过去一个月中使用非法药物的中位数天数从 10 天减少到 0 天（p<0.001）。渴望改善：29.2%的人在入组时没有渴望，58.3%的人在 3 个月时没有渴望（p<0.001）。3 个月时的保留率为 92.5%。未处于缓刑/假释状态的参与者的保留率（96.9%）高于处于缓刑/假释状态的参与者（62.5%，p=0.021）。
这项研究初步表明，一种基于简便和灵活的获取途径以及改善治疗保留率的策略的护理模式，可以提高康复资本，减少非法药物使用和渴望，并使更多的人留在治疗中。
