Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA.
Subst Abus. 2023 Jan-Apr;44(1):41-50. doi: 10.1177/08897077231165625. Epub 2023 May 3.
Patients receiving buprenorphine for the treatment of opioid use disorder (OUD) experience a roughly 50% reduction in mortality risk relative to those not receiving medication. Longer periods of treatment are also associated with improved clinical outcomes. Despite this, patients often express desires to discontinue treatment and some view taper as treatment success. Little is known about the beliefs and medication perspectives of patients engaged in long-term buprenorphine treatment that may underlie motivations to discontinue.
This study was conducted at the VA Portland Health Care System (2019-2020). Qualitative interviews were conducted with participants prescribed buprenorphine for ≥2 years. Coding and analysis were guided by directed qualitative content analysis.
Fourteen patients engaged in office-based buprenorphine treatment completed interviews. While patients expressed strong enthusiasm for buprenorphine as a medication, the majority expressed the desire to discontinue, including patients actively tapering. Motivations to discontinue fell into 4 categories. First, patients were troubled by perceived side effects of the medication, including effects on sleep, emotion, and memory. Second, patients expressed unhappiness with being "dependent" on buprenorphine, framed in opposition to personal strength/independence. Third, patients expressed stigmatized beliefs about buprenorphine, describing it as "illicit," and associated with past drug use. Finally, patients expressed fears about buprenorphine unknowns, including potential long-term health effects and interactions with medications required for surgery.
Despite recognizing benefits, many patients engaged in long-term buprenorphine treatment express a desire to discontinue. Findings from this study may help clinicians anticipate patient concerns and can be used to inform shared decision-making conversations regarding buprenorphine treatment duration.
接受丁丙诺啡治疗阿片类药物使用障碍（OUD）的患者的死亡率风险降低了约 50%，而未接受药物治疗的患者死亡率风险则降低了。治疗时间更长也与改善临床结局有关。尽管如此，患者通常表示希望停止治疗，一些人认为逐渐减少剂量是治疗成功的表现。人们对长期接受丁丙诺啡治疗的患者在停药动机方面的信念和药物观点知之甚少。
本研究在退伍军人事务部波特兰医疗保健系统进行（2019-2020 年）。对服用丁丙诺啡≥2 年的患者进行了定性访谈。编码和分析由定向定性内容分析指导。
14 名患者接受了门诊丁丙诺啡治疗并完成了访谈。虽然患者对丁丙诺啡作为一种药物表现出强烈的热情，但大多数患者表达了停药的愿望，包括正在逐渐减少剂量的患者。停药的动机分为 4 类。首先，患者对药物的副作用感到困扰，包括对睡眠、情绪和记忆的影响。其次，患者对依赖丁丙诺啡表示不满，认为这与个人的力量/独立性相矛盾。第三，患者表达了对丁丙诺啡的污名化信念，将其描述为“非法”，并与过去的药物使用有关。最后，患者对丁丙诺啡的未知因素表示担忧，包括潜在的长期健康影响和与手术所需药物的相互作用。
尽管许多接受长期丁丙诺啡治疗的患者认识到了这种药物的益处，但他们仍表达了停药的愿望。本研究的结果可能有助于临床医生预测患者的担忧，并可用于为丁丙诺啡治疗持续时间的共同决策对话提供信息。
