Washington University in St. Louis School of Medicine, St. Louis, USA.
Division of Toxicology, Department of Emergency Medicine, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave. Campus, Box 8072, St. Louis, MO, 63110, USA.
J Med Toxicol. 2022 Jan;18(1):11-18. doi: 10.1007/s13181-021-00858-z. Epub 2021 Sep 23.
Currently, few hospitals provide medications for opioid use disorder (MOUD) to admitted patients with opioid use disorder (OUD). Data are needed to inform whether the choice of medication during hospitalization influences probability of retention in outpatient OUD treatment.
This was a retrospective cohort analysis of patients who received a medical toxicology consult for OUD. Medical records were reviewed to determine if patients received MOUD and were referred to Engaging Patients in Care Coordination (EPICC), a service that connects hospitalized patients with OUD to outpatient care. Patients were stratified by the last form of MOUD they received in the hospital (methadone verses buprenorphine); retention in outpatient treatment was measured at 2 weeks, 30 days, and 12 weeks. The log-rank test was used to determine the difference in probabilities of retention in the methadone and buprenorphine groups. An event was defined as drop-out from outpatient treatment.
Of 267 total patients with medical toxicology consults for OUD, 155 received MOUD and referral to EPICC. One hundred six patients received buprenorphine and 46 received methadone. Three additional patients were excluded. The rate of retention in outpatient treatment for patients who received buprenorphine was 37%, 26%, and 13% and for patients who received methadone was 43%, 39%, and 35% at 2 weeks, 30 days, and 12 weeks, respectively. Methadone was associated with a statistically significant increased probability of retention in outpatient treatment as compared to buprenorphine (P < 0.01).
Despite the limitations of this retrospective study, in hospitalized patients who received MOUD, the probability of retention in outpatient treatment was higher in patients receiving methadone compared to buprenorphine.
目前，很少有医院为患有阿片类药物使用障碍（OUD）的住院患者提供阿片类药物使用障碍（MOUD）药物。需要数据来告知住院期间选择的药物是否会影响门诊 OUD 治疗的保留率。
这是一项对接受阿片类药物使用障碍医学毒理学咨询的患者进行的回顾性队列分析。审查病历以确定患者是否接受 MOUD 治疗并转介到参与患者护理协调（EPICC），该服务将患有 OUD 的住院患者与门诊护理联系起来。根据他们在医院接受的最后一种 MOUD 药物（美沙酮与丁丙诺啡）对患者进行分层；通过 2 周、30 天和 12 周来衡量门诊治疗的保留率。对数秩检验用于确定美沙酮和丁丙诺啡组保留率的差异。事件定义为退出门诊治疗。
在总共 267 名接受医学毒理学咨询的阿片类药物使用障碍患者中，有 155 名接受 MOUD 和 EPICC 转介。106 名患者接受丁丙诺啡治疗，46 名患者接受美沙酮治疗。另外还有 3 名患者被排除在外。接受丁丙诺啡治疗的患者门诊治疗保留率分别为 37%、26%和 13%，接受美沙酮治疗的患者保留率分别为 43%、39%和 35%，分别为 2 周、30 天和 12 周。与丁丙诺啡相比，美沙酮与门诊治疗保留的概率显著增加（P < 0.01）。
尽管这项回顾性研究存在局限性，但在接受 MOUD 的住院患者中，与丁丙诺啡相比，接受美沙酮治疗的患者门诊治疗保留率更高。
