Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Drug Alcohol Depend. 2021 Aug 1;225:108786. doi: 10.1016/j.drugalcdep.2021.108786. Epub 2021 May 27.
Opioid overdose remains a leading cause of death. Office-based buprenorphine could expand access to treatment to the many opioid users who are not in treatment and who are at risk for opioid overdose. However, many people in need of buprenorphine treatment do not enroll in treatment. This randomized pilot trial evaluated efficacy of a remotely delivered incentive intervention in promoting engagement in buprenorphine treatment in out-of-treatment adults with opioid use disorder.
Participants (N = 41) were offered referrals to buprenorphine treatment and randomly assigned to Control or Incentive groups for 6 months. Incentive participants were offered incentives for enrolling in buprenorphine treatment, verified by providing documentation showing that they received a buprenorphine prescription, and providing videos taking daily buprenorphine doses. Participants used a smartphone application to record and submit a video of their buprenorphine prescription and daily buprenorphine administration. Incentive earnings were added remotely to reloadable credit cards.
Incentive participants were significantly more likely to enroll in treatment compared to control participants (71.4 % versus 30.0 % of participants; OR [95 % CI]: 6.24 [1.46-26.72], p = .014). Few participants in either group adhered to buprenorphine treatment, and the two groups continued to use opioids, including fentanyl at high and comparable rates. The two groups did not differ in the percentage of urine samples that were positive for buprenorphine, opiates, fentanyl, or methadone at monthly assessments conducted during the 6-month intervention.
Remotely delivered incentives can connect out-of-treatment adults with opioid use disorder to treatment, but additional supports are needed to promote buprenorphine adherence.
阿片类药物过量仍是导致死亡的主要原因。在诊所有资质的丁丙诺啡可扩大接受治疗的机会，让更多未接受治疗且有阿片类药物过量风险的阿片类药物使用者接受治疗。然而，许多需要丁丙诺啡治疗的人并未接受治疗。这项随机试点试验评估了远程提供激励干预措施对促进未接受治疗的阿片类药物使用障碍成年人参与丁丙诺啡治疗的效果。
参与者（N=41）被提供丁丙诺啡治疗的转介，并随机分为对照组或激励组，接受 6 个月的治疗。激励组参与者获得激励以参加丁丙诺啡治疗，通过提供显示他们收到丁丙诺啡处方的文件和提供每日丁丙诺啡剂量的视频来验证。参与者使用智能手机应用程序记录并提交他们的丁丙诺啡处方和每日丁丙诺啡给药的视频。激励收入通过远程添加到可充值的信用卡中。
与对照组相比，激励组参与者更有可能参加治疗（71.4%与 30.0%的参与者；比值比[95%置信区间]：6.24[1.46-26.72]，p=0.014）。两组参与者都很少坚持丁丙诺啡治疗，两组都继续使用阿片类药物，包括以高剂量和相当的比率使用芬太尼。在 6 个月的干预期间每月进行的评估中，两组尿液样本中丁丙诺啡、阿片类药物、芬太尼或美沙酮呈阳性的比例没有差异。
远程提供的激励措施可以将未接受治疗的阿片类药物使用障碍成年人与治疗联系起来，但需要额外的支持来促进丁丙诺啡的坚持。
