Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA; Spectrum Healthcare Partners, 324 Gannett Dr, Suite 200, South Portland, ME 04106, USA.
Department of Pharmacy, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA.
J Subst Use Addict Treat. 2023 Dec;155:209176. doi: 10.1016/j.josat.2023.209176. Epub 2023 Sep 29.
Buprenorphine is highly effective for the treatment of opioid use disorder (OUD), and, in recent years, the rates of patients maintained on buprenorphine requiring critical care have been steadily increasing. Currently, no unified guidance exists for buprenorphine management during critical illness. Likewise, we do not know if patients maintained on buprenorphine for OUD are prescribed medications for OUD (MOUD) following hospital discharge or if buprenorphine management influences mu opioid agonist dispensing.
In our cohort of adults over the age of 18 with OUD, receiving buprenorphine formulations in the 3 months preceding their ICU admission, we sought to investigate the relationship between receipt of MOUD and non-MOUD opioid prescribing up to 12 months following hospital discharge. This was a single-center, retrospective cohort study approved by the MaineHealth institutional review board. The study analyzed differences in prescription rates between discharge and subsequent time points using chi square or Fisher's exact test, as appropriate. We performed analyses using SPSS Statistical Software version 28 (IBM SPSS Inc., Armonk, NY) with significance set at p < 0.05.
We identified a statistically significant increase in MOUD prescribing 3 months posthospital discharge in patients who received MOUD at time of discharge (87.9 % vs 40 % p = 0.002.) The study found a significant increase in nonbuprenorphine opioid prescribing in patients who did not receive an MOUD prescription at time of discharge (24.2 % vs 70 % p = 0.007). This trend persisted at the 6-month and 12-month time points; however, it did not reach statistical significance. Additionally, the study identified a significant reduction in the incidence of non-MOUD opioid dispensing in patients prescribed MOUD at each time point measured (p = 0.007, p < 0.001. p < 0.001 and p = 0.008 at discharge, 3, 6, and 12 months, respectively).
These findings support continuing buprenorphine dispensing following hospital discharge.
丁丙诺啡对于治疗阿片类药物使用障碍（OUD）非常有效，近年来，需要重症监护的接受丁丙诺啡治疗的患者的比例一直在稳步上升。目前，对于危重病患者的丁丙诺啡管理尚无统一的指导意见。同样，我们也不知道接受丁丙诺啡治疗 OUD 的患者在出院后是否会开 OUD 治疗药物（MOUD），或者丁丙诺啡管理是否会影响 mu 阿片激动剂的配给。
在我们的研究队列中，纳入了年龄在 18 岁以上的患有 OUD 的成年人，在入住 ICU 前的 3 个月内接受丁丙诺啡制剂治疗，我们试图调查在出院后 12 个月内接受 MOUD 和非 MOUD 阿片类药物处方之间的关系。这是一项经缅因州健康机构审查委员会批准的单中心回顾性队列研究。该研究使用卡方检验或 Fisher 精确检验分析出院时和随后各时间点的处方率差异，具体取决于适用情况。我们使用 SPSS 统计软件版本 28（IBM SPSS Inc.，Armonk，NY）进行分析，显著性水平设为 p < 0.05。
我们发现，在出院时接受 MOUD 治疗的患者中，出院后 3 个月时 MOUD 处方的开具率显著增加（87.9%比 40%，p = 0.002）。研究发现，在出院时未开具 MOUD 处方的患者中，非丁丙诺啡类阿片类药物的开具率显著增加（24.2%比 70%，p = 0.007）。这一趋势在 6 个月和 12 个月的时间点仍然存在，但没有达到统计学意义。此外，研究还发现，在每个测量时间点，开具 MOUD 处方的患者的非 MOUD 阿片类药物配给率显著降低（p = 0.007，p < 0.001，p < 0.001 和 p = 0.008，分别为出院时、3 个月、6 个月和 12 个月）。
这些发现支持在出院后继续开具丁丙诺啡。
