National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
Corresponding author: Kun Zhang, PhD, Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA 30341 (
J Clin Psychiatry. 2022 Apr 27;83(3):21m14001. doi: 10.4088/JCP.21m14001.
Clinical interventions targeting co-occurring psychiatric disorders may represent a tangible target for improving retention in buprenorphine treatment for opioid use disorder. The aims of this study are to characterize receipt of antidepressants among patients receiving buprenorphine treatment and to examine the association between receiving antidepressants and retention in treatment. A retrospective cohort design was used. Using data from a large national commercially insured population, the cohort was selected as adults aged 18 to 64 years who initiated buprenorphine treatment in outpatient settings between January 1, 2016, and June 30, 2017. Receiving antidepressants was identified as prescription fills in the period between 6 months prior to buprenorphine initiation and during buprenorphine treatment. Buprenorphine discontinuation was defined as no buprenorphine prescription supply for at least 60 days following the end of the last buprenorphine prescription. The cohort consisted of 11,619 individuals who initiated buprenorphine treatment and met our inclusion criteria. The cohort had a mean age of 36.3 years, 63% were male, and 55.7% received at least 1 antidepressant prescription at any time between 6 months prior to buprenorphine initiation and during treatment. Compared with those receiving no antidepressants at all, individuals starting antidepressants during buprenorphine treatment had an adjusted hazard ratio (HR) for treatment discontinuation of 0.72 (95% CI = 0.67-0.77), while receiving antidepressants only prior to buprenorphine initiation was associated with an increased risk of treatment discontinuation (HR = 1.40, 95% CI = 1.28-1.53). Findings suggest that receiving antidepressants during buprenorphine treatment is associated with improved retention. This highlights the critical importance of screening for and treating mental disorders concomitantly with treatment of opioid use disorder.
针对共病精神障碍的临床干预可能是提高阿片类药物使用障碍接受丁丙诺啡治疗保留率的切实目标。本研究的目的是描述接受丁丙诺啡治疗的患者接受抗抑郁药的情况，并探讨接受抗抑郁药与治疗保留之间的关系。本研究采用回顾性队列设计。利用来自一个大型全国商业保险人群的数据，该队列选择了年龄在 18 至 64 岁之间的成年人，他们在 2016 年 1 月 1 日至 2017 年 6 月 30 日期间在门诊环境下开始丁丙诺啡治疗。接受抗抑郁药是指在开始丁丙诺啡治疗前 6 个月和丁丙诺啡治疗期间开具的处方。丁丙诺啡停药定义为最后一次丁丙诺啡处方结束后至少 60 天没有丁丙诺啡处方供应。该队列包括 11619 名开始丁丙诺啡治疗并符合纳入标准的个体。该队列的平均年龄为 36.3 岁，63%为男性，55.7%在开始丁丙诺啡治疗前 6 个月和治疗期间至少接受过一次抗抑郁药处方。与根本不接受抗抑郁药的个体相比，在丁丙诺啡治疗期间开始使用抗抑郁药的个体，其治疗停药的调整后危险比（HR）为 0.72（95%CI=0.67-0.77），而仅在开始丁丙诺啡治疗前接受抗抑郁药与治疗停药风险增加相关（HR=1.40，95%CI=1.28-1.53）。研究结果表明，在丁丙诺啡治疗期间接受抗抑郁药与保留率提高有关。这突出表明，筛查和同时治疗精神障碍对于治疗阿片类药物使用障碍至关重要。
