Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, United States of America; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, United States of America.
Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States of America.
J Subst Abuse Treat. 2022 Aug;139:108774. doi: 10.1016/j.jsat.2022.108774. Epub 2022 Mar 18.
Current evidence indicates that buprenorphine is a highly effective treatment for opioid use disorder (OUD), though premature medication discontinuation is common. Research on concurrent psychosocial and behavioral therapy services and related outcomes is limited. The goal of this study was to define patterns of OUD-related psychosocial and behavioral therapy services received in the first 6 months after buprenorphine initiation, identify patients' characteristics associated with service patterns, and examine the course of buprenorphine treatment, including the association of therapy with medication treatment duration.
We analyzed 2013-2018 MarketScan Multi-State Medicaid claims data. The sample included adults aged 18-64 years at buprenorphine initiation with treatment episodes of at least 7 days (n = 61,976). We used group-based trajectory models to define therapy service patterns and multinomial logistic regression to identify pre-treatment patient characteristics associated with therapy trajectories. Multinomial propensity-score weighted Cox proportional hazards regression estimated time to buprenorphine discontinuation and unweighted Cox proportional hazards models estimated risk of adverse health care events during buprenorphine treatment (all-cause and opioid-related inpatient and emergency department services, overdose treatment).
We identified three trajectories of psychosocial and behavioral therapy services: none (73.8%), low-intensity (17.2%), and high-intensity (9.0%). Compared to those without therapy, low-intensity and high-intensity service patterns were associated with behavioral health diagnoses and medical treatment for opioid overdose in the baseline period prior to buprenorphine initiation. The hazard of buprenorphine discontinuation was significantly lower for low-intensity (HR = 0.55; 95% CI, 0.54-0.57) and high-intensity (HR = 0.71; 95% CI, 0.67-0.74) therapy groups compared to those without therapy services. Yet patients in the high-intensity therapy group had increased risk of opioid-related health care events during buprenorphine treatment, including medical treatment for opioid overdose (HR = 1.29; 95% CI, 1.01-1.64).
Most patients received little or no OUD-related psychosocial and behavioral therapy after initiating buprenorphine treatment. Patients who received therapy had characteristics indicating greater treatment needs as well as more complex treatment courses. Concurrent therapy services may help to address premature buprenorphine discontinuation, particularly for patients with high-risk clinical profiles; however, future prospective research should determine whether therapy is effective for extending buprenorphine retention.
目前的证据表明，丁丙诺啡是治疗阿片类药物使用障碍（OUD）的有效方法，尽管过早停药很常见。关于同时进行的心理社会和行为治疗服务及相关结果的研究有限。本研究的目的是确定丁丙诺啡治疗开始后 6 个月内 OUD 相关心理社会和行为治疗服务的模式，确定与服务模式相关的患者特征，并检查丁丙诺啡治疗的过程，包括治疗与药物治疗持续时间的关系。
我们分析了 2013-2018 年 MarketScan 多州医疗补助索赔数据。样本包括丁丙诺啡治疗开始时年龄在 18-64 岁、治疗期至少 7 天的成年人（n=61976）。我们使用基于群组的轨迹模型来定义治疗服务模式，并使用多项逻辑回归来确定治疗前与治疗轨迹相关的患者特征。多项倾向评分加权 Cox 比例风险回归估计丁丙诺啡停药时间，未加权 Cox 比例风险模型估计丁丙诺啡治疗期间（所有原因和阿片类药物相关的住院和急诊服务、过量治疗）不良医疗事件的风险。
我们确定了三种心理社会和行为治疗服务模式：无（73.8%）、低强度（17.2%）和高强度（9.0%）。与没有治疗的患者相比，低强度和高强度服务模式与阿片类药物过量的行为健康诊断和基线期（即丁丙诺啡治疗前）的医疗治疗相关。与没有治疗服务的患者相比，低强度（HR=0.55；95%CI，0.54-0.57）和高强度（HR=0.71；95%CI，0.67-0.74）治疗组的丁丙诺啡停药风险显著降低。然而，高强度治疗组在丁丙诺啡治疗期间发生阿片类药物相关医疗事件的风险增加，包括阿片类药物过量的医疗治疗（HR=1.29；95%CI，1.01-1.64）。
大多数患者在开始丁丙诺啡治疗后接受的 OUD 相关心理社会和行为治疗很少或没有。接受治疗的患者具有更大的治疗需求和更复杂的治疗过程的特征。同时进行的治疗服务可能有助于解决丁丙诺啡过早停药的问题，特别是对于具有高风险临床特征的患者；然而，未来的前瞻性研究应确定治疗是否有助于延长丁丙诺啡的保留时间。
