National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.
Université de Montréal and Centre de Recherche du CHUM, Montreal, Canada.
Addiction. 2021 Nov;116(11):3139-3152. doi: 10.1111/add.15514. Epub 2021 May 12.
BACKGROUND AND AIMS: There is limited evidence on the relationship between retention in opioid agonist treatment for opioid dependence and characteristics of treatment prescribers. This study estimated retention in buprenorphine and methadone treatment and its relationship with person, treatment and prescriber characteristics. DESIGN: Retrospective longitudinal study. SETTING: New South Wales, Australia. PARTICIPANTS: People entering the opioid agonist treatment programme for the first time between August 2001 and December 2015. MEASUREMENTS: Time in opioid agonist treatment (primary outcome) was modelled using a generalized estimating equation model to estimate associations with person, treatment and prescriber characteristics. FINDINGS: The impact of medication type on opioid agonist treatment retention reduced over time; the risk of leaving treatment when on buprenorphine compared with methadone was higher among those who entered treatment earlier [e.g. 2001-03: odds ratio (OR) = 1.59, 95% confidence interval (CI) = 1.45-1.75] and lowest among those who entered most recently (2013-15: OR = 1.23, 95% CI = 1.11-1.36). In adjusted analyses, risk of leaving was reduced among people whose prescriber had longer tenure of prescribing (e.g. 3 versus 8 years: OR = 0.94, 95% CI = 0.93-0.95) compared with prescribers with shorter tenure. Aboriginal and Torres Strait Islander people, being of younger age, past-year psychosis disorder and having been convicted of more criminal charges in the year prior to treatment entry were associated with increased risk of leaving treatment. CONCLUSION: In New South Wales, Australia, retention in buprenorphine treatment for opioid dependence, compared with methadone, has improved over time since its introduction in 2001. Opioid agonist treatment retention is affected not only by characteristics of the person and his or her treatment, but also of the prescriber, with those of longer prescribing tenure associated with increased retention of people in opioid agonist treatment.
背景与目的:关于阿片类药物依赖患者接受阿片类激动剂治疗的保留率与治疗提供者特征之间的关系,目前证据有限。本研究旨在评估丁丙诺啡和美沙酮治疗的保留率及其与个人、治疗和处方者特征的关系。 设计:回顾性纵向研究。 地点:澳大利亚新南威尔士州。 参与者:2001 年 8 月至 2015 年 12 月首次进入阿片类激动剂治疗计划的人群。 测量方法:使用广义估计方程模型对阿片类激动剂治疗时间(主要结局)进行建模,以评估与个人、治疗和处方者特征的关联。 结果:药物类型对阿片类激动剂治疗保留率的影响随时间推移而降低;与接受美沙酮治疗相比,接受丁丙诺啡治疗的人离开治疗的风险更高,尤其是在较早进入治疗的人群中(例如,2001-03 年:比值比(OR)=1.59,95%置信区间(CI)=1.45-1.75),而在最近进入治疗的人群中风险最低(2013-15 年:OR=1.23,95%CI=1.11-1.36)。在调整分析中,与处方者从业时间较短的人相比(例如,3 年与 8 年:OR=0.94,95%CI=0.93-0.95),从业时间较长的处方者的患者离开治疗的风险降低。土著和托雷斯海峡岛民、年龄较小、过去一年患有精神病障碍以及在治疗前一年被定罪的次数较多的人,离开治疗的风险增加。 结论:在澳大利亚新南威尔士州,自 2001 年丁丙诺啡引入以来,与美沙酮相比,丁丙诺啡治疗阿片类药物依赖的保留率随着时间的推移有所提高。阿片类激动剂治疗的保留率不仅受患者及其治疗的特征影响,还受处方者的特征影响,从业时间较长的处方者与阿片类激动剂治疗患者的保留率增加有关。
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