Ambulatory Care Network, Department of Health Services, Los Angeles County, Los Angeles, CA, USA.
Health Sciences Library Systems, University of Pittsburgh, Pittsburgh, PA, USA.
J Gen Intern Med. 2022 Feb;37(2):332-340. doi: 10.1007/s11606-020-06448-z. Epub 2021 Jan 19.
The average length of buprenorphine treatment for opioid use disorder is less than 6 months.
We conducted a systematic review to determine what factors were associated with longer retention in buprenorphine treatment.
We searched Medline, Embase, and Cochrane Database of Systematic Reviews in February 2018. Articles were restricted to randomized controlled trials on human subjects, written in English, which contained ≥ 24 weeks of objective data on retention in buprenorphine treatment.
We assessed whether dose of buprenorphine, treatment setting, or co-administration of behavioral therapy was associated with retention rates.
Over 14,000 articles were identified. Thirteen articles (describing 9 studies) met inclusion criteria. Measures of retention varied widely. Three studies compared doses of buprenorphine between 1 and 8 mg and showed significantly higher rates of retention with higher doses (p values < 0.01). All other studies utilized buprenorphine doses between 8 and 24 mg daily, without comparison. No study found a significant difference in retention between buprenorphine alone and buprenorphine plus behavioral therapy (p values > 0.05). Initiating buprenorphine while hospitalized or within criminal justice settings prior to outpatient treatment programs was significantly associated with retention in buprenorphine treatment (p values < 0.01 respectively).
Setting of treatment initiation and a higher buprenorphine dose are associated with improved long-term treatment retention. More objective data on buprenorphine treatment programs are needed, including a standardized approach to defining retention in buprenorphine treatment programs.
This review was registered with PROSPERO (#CRD42019120336) in March 2019.
阿片类药物使用障碍的丁丙诺啡治疗平均持续时间不足 6 个月。
我们进行了一项系统评价，以确定哪些因素与丁丙诺啡治疗的长期保留有关。
我们于 2018 年 2 月在 Medline、Embase 和 Cochrane 系统评价数据库中进行了检索。文章仅限于针对人类受试者的随机对照试验，用英文书写，包含丁丙诺啡治疗保留期的客观数据至少 24 周。
我们评估了丁丙诺啡剂量、治疗环境或行为治疗联合应用是否与保留率相关。
共检索到 14000 多篇文章。符合纳入标准的有 13 篇文章（描述了 9 项研究）。保留率的衡量标准差异很大。有 3 项研究比较了 1 至 8 毫克之间的丁丙诺啡剂量，结果显示高剂量的保留率显著更高（p 值均<0.01）。所有其他研究均使用每日 8 至 24 毫克的丁丙诺啡剂量，没有进行比较。没有研究发现丁丙诺啡单独治疗与丁丙诺啡联合行为治疗之间保留率存在显著差异（p 值均>0.05）。与门诊治疗方案相比，在住院期间或在刑事司法系统中启动丁丙诺啡治疗与丁丙诺啡治疗的保留显著相关（p 值分别<0.01）。
治疗开始时的环境和较高的丁丙诺啡剂量与长期治疗保留率的提高有关。需要更多关于丁丙诺啡治疗方案的客观数据，包括丁丙诺啡治疗方案保留率的标准化方法。
本研究于 2019 年 3 月在 PROSPERO（#CRD42019120336）进行了注册。
