科罗拉多州农村地区阿片类药物使用障碍成年人药物辅助治疗试点项目的结果。
Outcomes from the medication assisted treatment pilot program for adults with opioid use disorders in rural Colorado.
机构信息
University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
Present address: Rush University College of Medicine, Chicago, IL, 60612, USA.
出版信息
Subst Abuse Treat Prev Policy. 2022 Jan 3;17(1):1. doi: 10.1186/s13011-021-00424-4.
BACKGROUND
As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence- based treatment to 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1005 patients receiving MOUD from the 3 participating organizations. Here we evaluate patient centered clinical and functional outcomes of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis.
METHODS
Under state-funded law (Colorado Senate Bill 17-074), three rural agencies submitted de-identified patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index, PhQ9 and GAD-7 with McNemar-Bowker, and Wilcoxon Signed Rank tests analysis were used to measure patient outcomes across after participation in the program. .
RESULTS
Patients in treatment reported using less heroin (52.1% vs 20.4%), opioids (22.3% vs 11.0%), and alcohol (28.6% vs 13.1%, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less frequency of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5% to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment.
CONCLUSIONS
This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado' major public health crises.
背景
科罗拉多州在非医疗用途的阿片类药物使用方面位列全美前列，因此开发了一项试点药物治疗阿片类药物使用障碍（MOUD）计划，以增加提供 MOUD 的护士执业者和医师助理的数量，从而为 2 个显示阿片类药物过量死亡率过高的县提供这种基于证据的治疗方法。在最初的 18 个月中，MOUD 试点计划使 15 名新的医疗保健提供者接受了 MOUD 豁免培训，3 家参与机构的 1005 名患者接受了 MOUD。在这里，我们评估了在受阿片类药物危机严重影响的 2 个农村县实施的试点 MOUD 计划的以患者为中心的临床和功能结果。
方法
根据州资助的法律（科罗拉多州参议院法案 17-074），3 家农村机构于 2017 年 12 月至 2020 年 1 月期间提交了基线（N=1005）和治疗后 6 个月（N=190，25%）的患者水平的匿名数据。使用成瘾严重程度指数、PhQ9 和 GAD-7 以及 McNemar-Bowker 和 Wilcoxon 符号秩检验分析来衡量患者在参与该计划后的结果。
结果
接受治疗的患者报告使用海洛因（52.1%对 20.4%）、阿片类药物（22.3%对 11.0%）和酒精（28.6%对 13.1%）的频率降低（均 P<0.01）。患者报告健康状况改善（53.4%对 68.2%，P=0.04），残疾频率降低（8.69 对 6.51，P=0.02），症状（29.8%对 21.3%），疼痛（67.5%至 53.6%），担忧（45.3%对 62.3%），焦虑（49.7%对 23.2%），抑郁（54.1%对 23.3%，均 P<0.02）。
结论
这项研究表明，接受 MOUD 治疗 6 个月后，物质使用减少，身心健康改善，症状减轻。尽管需要更多关于保留率和长期效果的研究，但数据显示，接受 MOUD 治疗 6 个月后，健康结果得到改善。从实施该试点计划中吸取的经验教训为该计划在其他需要解决科罗拉多州一些重大公共卫生危机的农村地区的扩展提供了信息。
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