Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Ann Med. 2023 Dec;55(1):733-743. doi: 10.1080/07853890.2023.2182908.
At the start of the pandemic, relaxation of buprenorphine prescribing regulations created an opportunity to create new models of medications for opioid use disorder (MOUD) delivery and care. To expand and improve access to MOUD, we adapted and implemented the intervention; a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted intervention at the IDEA Miami SSP. A retrospective chart review of participants who received the intervention for MOUD was performed to examine the impact of telehealth on buprenorphine retention. Our primary outcome was three-month retention, defined as three consecutive months of buprenorphine dispensed from the pharmacy. A total of 109 participants received the adapted intervention. Three-month retention rate on buprenorphine was 58.7%. Seeing a provider telehealth at baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) and participants who had received an escalating dose of buprenorphine after baseline visit (aOR = 8.09, 95% CI: [1.83, 35.87]) had a higher adjusted odds of retention at three months. Participants who self-reported or tested positive for a stimulant (methamphetamine, amphetamine, or cocaine) at baseline had a lower adjusted odds of retention on buprenorphine at three months (aOR = 0.29, 95% CI: [0.09, 0.93]). Harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatising approach. Our pilot suggests that an SSP may be an acceptable and feasible venue for delivery of to increase uptake of buprenorphine by PWID and promote retention in care.KEY MESSAGESThe Tele-Harm Reduction intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program settingUsing telehealth was associated with increased three-month buprenorphine retentionBaseline stimulant use was negatively associated with three-month buprenorphine retention.
在大流行开始时，放松丁丙诺啡处方规定为创建新的阿片类药物使用障碍（MOUD）药物提供和护理模式创造了机会。为了扩大和改善 MOUD 的可及性，我们对干预措施进行了调整和实施；这是一种多组分、基于远程医疗和同伴驱动的干预措施，旨在促进注射毒品者（PWID）接受注射器服务计划（SSP）的 HIV 病毒抑制。本研究检查了在 IDEA 迈阿密 SSP 接受改编后的 干预措施的阿片类药物使用障碍的 PWID 中丁丙诺啡的起始和保留情况。对接受 MOUD 干预措施的参与者进行了回顾性图表审查，以检查远程医疗对丁丙诺啡保留的影响。我们的主要结果是三个月的保留率，定义为连续三个月从药房开出丁丙诺啡。共有 109 名参与者接受了改编后的 干预措施。丁丙诺啡的三个月保留率为 58.7%。在基线或任何随访时接受医疗提供者远程医疗（aOR = 7.53，95%CI：[2.36，23.98]）和在基线后就诊时接受丁丙诺啡递增剂量的参与者（aOR = 8.09，95%CI：[1.83，35.87]）在三个月时有更高的调整后保留率。在基线时自我报告或检测出兴奋剂（甲基苯丙胺、苯丙胺或可卡因）呈阳性的参与者在三个月时保留丁丙诺啡的调整后几率较低（aOR = 0.29，95%CI：[0.09，0.93]）。减少伤害环境可以动态适应 PWID 的需求，以真正消除耻辱感的方式提供关键的救命丁丙诺啡。我们的试点表明，SSP 可能是提供 以增加 PWID 接受丁丙诺啡并促进护理保留的可接受且可行的场所。
关键信息
远程减少伤害干预措施可以适应为在注射器服务计划环境中启动和保留阿片类药物使用障碍的注射毒品者使用丁丙诺啡
使用远程医疗与增加三个月的丁丙诺啡保留率相关
基线兴奋剂使用与三个月的丁丙诺啡保留率呈负相关。
