Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States; School of Public Health, Oregon Health & Science University, 840 SW Gaines St, Portland, OR 97239, United States.
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, United States; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States.
Drug Alcohol Depend. 2021 Nov 1;228:108923. doi: 10.1016/j.drugalcdep.2021.108923. Epub 2021 Jul 29.
A growing body of research has examined adjunctive interventions supportive of engagement and retention in treatment among patients receiving buprenorphine for opioid use disorder (OUD). We conducted a systematic review of the literature addressing the effect on key outcomes of adjunctive interventions provided alongside standard medical management of buprenorphine in outpatient settings.
We included prospective studies examining adults receiving buprenorphine paired with an adjunctive intervention for the treatment of OUD in an outpatient setting. Data sources included Medline, Cochrane Central Register of Controlled Trials, CINAHL and PsycINFO from inception through January 2020. Two raters independently reviewed full-text articles, abstracted data and appraised risk of bias. Outcomes examined included abstinence, retention in treatment and non-addiction-related health outcomes.
The final review includes 20 manuscripts, 11 randomized control trials (RCTs), three secondary analyses of RCTs and six observational studies. Most studies examined psychosocial interventions (n = 14). Few examined complementary therapies (e.g., yoga; n = 2) or technological interventions (e.g., electronic pill dispensation; n = 3); one study examined an intervention addressing structural barriers to care (patient navigators; n = 1). Low risk of bias RCTs found no evidence that adding psychosocial interventions to buprenorphine treatment improves substance use outcomes.
Research is needed to identify adjunctive interventions with potential to support medication adherence and addiction-related outcomes for patients engaged in buprenorphine treatment. Data from clinical trials suggest that lack of ready access to psychosocial treatments should not discourage clinicians from prescribing buprenorphine.
越来越多的研究考察了辅助干预措施，以支持接受丁丙诺啡治疗阿片类药物使用障碍（OUD）的患者参与和坚持治疗。我们对文献进行了系统评价，探讨了在门诊环境下，除了丁丙诺啡标准医学管理之外，附加干预措施对关键结果的影响。
我们纳入了前瞻性研究，这些研究考察了在门诊环境下接受丁丙诺啡治疗并同时接受辅助干预治疗 OUD 的成年人。数据来源包括从建库至 2020 年 1 月的 Medline、Cochrane 对照试验中心注册库、CINAHL 和 PsycINFO。两名评审员独立审查全文文章、提取数据并评估偏倚风险。考察的结果包括戒除、治疗保留和与成瘾无关的健康结果。
最终的综述包括 20 篇文献，11 项随机对照试验（RCT）、3 项 RCT 的二次分析和 6 项观察性研究。大多数研究考察了心理社会干预（n=14）。很少有研究考察补充疗法（如瑜伽；n=2）或技术干预（如电子药丸分发；n=3）；一项研究考察了针对护理结构障碍的干预措施（患者导航员；n=1）。低偏倚风险的 RCT 发现，在丁丙诺啡治疗中添加心理社会干预并不能改善物质使用结果。
需要研究确定有潜力支持接受丁丙诺啡治疗的患者药物依从性和成瘾相关结果的辅助干预措施。临床试验数据表明，缺乏获得心理社会治疗的机会不应阻止临床医生开具丁丙诺啡。
