Substance Use Epidemiology Program, Rhode Island Department of Health, Providence, RI, USA.
Substance Use Epidemiology Program, Rhode Island Department of Health, Providence, RI, USA; Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA; Department of Epidemiology, Brown University, Providence, RI, USA.
Drug Alcohol Depend. 2022 Dec 1;241:109680. doi: 10.1016/j.drugalcdep.2022.109680. Epub 2022 Oct 30.
Partial opioid agonist medications for opioid use disorder reduce mortality and morbidity, however long-term retention in treatment is challenging. The objective of this study was to identify patient and prescription characteristics associated with long-term buprenorphine treatment retention.
We used data from the Rhode Island prescription drug monitoring program to identify residents who initiated buprenorphine treatment and determine if they were retained in long-term buprenorphine treatment 12-months after treatment initiation. Multivariable logistic regression models were used to identify sociodemographic and prescription characteristics associated with long-term buprenorphine retention.
During the study period 4898 unique Rhode Island residents initiated buprenorphine treatment, of whom 37.8 % were retained in treatment at 12-months. Demographic factors associated with a higher odds of long-term buprenorphine retention included older age, female sex, Medicaid insurance (vs private), and living closer to the pharmacy where the prescription was filled. Individuals who were prescribed the tablet formulation (aOR: 0.82 [95 % CI 0.72, 0.93]) or received a non-buprenorphine opioid during the follow-up window (aOR: 0.37 [95 % CI 0.31, 0.44]) had lower odds of long-term treatment at 12-months. Individuals who received at least one day of overlapping benzodiazepine and buprenorphine prescriptions (aOR: 2.00 [95 % CI 1.70, 2.34]) and those given a longer days supply (aOR: 1.26 [95 % CI 1.01, 1.56]) had higher odds of long-term treatment at 12-months. Findings were similar for treatment retention at 6-months in sensitivity analyses.
These findings highlight several modifiable prescribing practices associated with long-term buprenorphine retention, suggesting that clinicians and public health practitioners can help remove barriers to long-term retention.
用于治疗阿片类药物使用障碍的部分阿片类激动剂药物可降低死亡率和发病率，但长期治疗保留率具有挑战性。本研究的目的是确定与长期丁丙诺啡治疗保留相关的患者和处方特征。
我们使用罗德岛处方药监测计划的数据来确定开始丁丙诺啡治疗的居民，并确定他们在治疗开始后 12 个月是否长期保留丁丙诺啡治疗。多变量逻辑回归模型用于确定与长期丁丙诺啡保留相关的社会人口统计学和处方特征。
在研究期间，4898 名罗德岛独特居民开始接受丁丙诺啡治疗，其中 37.8%在 12 个月时保留在治疗中。与长期丁丙诺啡保留几率较高相关的人口统计学因素包括年龄较大、女性、医疗补助保险（而非私人保险）和居住在处方配药地点附近。处方丁丙诺啡片剂剂型（OR：0.82 [95%CI 0.72, 0.93]）或在随访期间接受非丁丙诺啡类阿片类药物（OR：0.37 [95%CI 0.31, 0.44]）的个体，12 个月时长期治疗的几率较低。至少接受一天丁丙诺啡和苯二氮䓬重叠处方（OR：2.00 [95%CI 1.70, 2.34]）和给予较长天数供应（OR：1.26 [95%CI 1.01, 1.56]）的个体，12 个月时长期治疗的几率较高。敏感性分析中，6 个月时的治疗保留率也存在类似结果。
这些发现突出了与长期丁丙诺啡保留相关的几种可修改的处方实践，表明临床医生和公共卫生从业人员可以帮助消除长期保留的障碍。
