Selitsky Lea, Nordeck Courtney, Truong Ashley, Agus Deborah, Buresh Megan E
Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, United States of America; Behavioral Health Leadership Institute, Baltimore, MD, United States of America.
J Subst Use Addict Treat. 2023 Apr;147:208981. doi: 10.1016/j.josat.2023.208981. Epub 2023 Feb 10.
Controversy exists regarding effective sublingual buprenorphine dosing for treatment of opioid use disorder (OUD), leading to dose caps of 16 mg per day. The Project Connections at Re-Entry (PCARE) program is a low-threshold buprenorphine clinic that provides medication for OUD to vulnerable populations in Baltimore City.
To compare retention in care based on treatment dose of buprenorphine, and to examine associated population characteristics.
This analysis includes clinical patients who received buprenorphine treatment at PCARE between January and July 2021. The study categorized patients into two dosing groups (16 mg or >16 mg). We conducted chi-square tests of independence for categorical variables and independent sample t-tests for continuous variables to evaluate any significant differences in demographic and clinical characteristics by dosing category. To examine differences in 30- and 90-day retention, we conducted multivariable logistic regression analyses with the outcome variable defined as successful retention (at 30 and 90 days, respectively) controlling for demographic and clinical characteristics.
In the study period, 566 patients received buprenorphine treatment at the PCARE van. Patients were primarily male (70.9 %), Black (89.4 %), had a mean age of 46.3 years (SD = 11.5), and a mean opioid use of 22.1 years (SD = 13.5). The majority had previous criminal justice involvement (73.9 %), Medicaid insurance coverage (75.4 %), and were unemployed (69.6 %). Nearly half of the sample had reported a previous overdose event (48.4 %). The study found no significant demographic differences between patients receiving 16 mg of buprenorphine per day compared to patients receiving >16 mg. Patients receiving >16 mg had significantly higher rates of treatment retention at 30 and 90 days: 95.4 % vs 86.7 % (p = 0.001), and 82.7 % vs. 67.6 % (p < 0.001) than those receiving 16 mg, respectively. In a multivariable logistic regression controlling for demographic and drug use characteristics, odds of 30-day (Adjusted Odds Ratio [AOR] = 3.98, 95 % Confidence Interval [CI] = 1.92, 8.74, p < 0.001) and 90-day retention (AOR = 2.56, 95 % CI = 1.55, 4.22, p < 0.001) were greater among patients receiving >16 mg daily compared to 16 mg.
In this study examining patients with OUD in a low-threshold buprenorphine clinic, we observed higher rates of treatment retention with buprenorphine doses >16 mg.
关于舌下含服丁丙诺啡治疗阿片类物质使用障碍（OUD）的有效剂量存在争议，导致每日剂量上限为16毫克。重返社会项目联系（PCARE）计划是一家低门槛丁丙诺啡诊所，为巴尔的摩市的弱势群体提供治疗OUD的药物。
比较基于丁丙诺啡治疗剂量的治疗留存率，并研究相关的人群特征。
本分析纳入了2021年1月至7月在PCARE接受丁丙诺啡治疗的临床患者。该研究将患者分为两个剂量组（16毫克或>16毫克）。我们对分类变量进行了独立性卡方检验，对连续变量进行了独立样本t检验，以评估不同剂量组在人口统计学和临床特征方面的任何显著差异。为了研究30天和90天留存率的差异，我们进行了多变量逻辑回归分析，将结果变量定义为成功留存（分别在30天和90天），并控制人口统计学和临床特征。
在研究期间，566名患者在PCARE流动诊所接受了丁丙诺啡治疗。患者主要为男性（70.9%），黑人（89.4%），平均年龄46.3岁（标准差=11.5），平均阿片类物质使用年限22.1年（标准差=13.5）。大多数人曾有刑事司法相关经历（73.9%），有医疗补助保险（75.4%），且失业（69.6%）。近一半的样本曾报告有过过量用药事件（48.4%）。该研究发现，与接受>16毫克丁丙诺啡的患者相比，接受每日16毫克丁丙诺啡的患者在人口统计学上没有显著差异。接受>16毫克的患者在30天和90天的治疗留存率显著更高：分别为95.4%和86.7%（p=0.001），以及82.7%和67.6%（p<0.001），而接受16毫克的患者相应留存率分别为86.7%和67.6%。在控制人口统计学和药物使用特征的多变量逻辑回归分析中，每日接受>16毫克的患者30天留存（调整后的优势比[AOR]=3.98，95%置信区间[CI]=1.92，8.74，p<0.001）和90天留存（AOR=2.56，95%CI=1.55，4.22，p<0.001）的优势比高于接受16毫克的患者。
在这项针对低门槛丁丙诺啡诊所中OUD患者的研究中，我们观察到丁丙诺啡剂量>16毫克时治疗留存率更高。
