Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States; Research Foundation for Mental Hygiene, 1051 Riverside Dr, New York, NY 10032, United States.
Columbia University Mailman School of Public Health, 722 W. 168th St, New York, NY 10032, United States.
Drug Alcohol Depend. 2024 Oct 1;263:112389. doi: 10.1016/j.drugalcdep.2024.112389. Epub 2024 Aug 13.
Challenges to engagement and retention on buprenorphine undermine treatment of individuals with opioid use disorder (OUD). Under the OUD Cascade of Care framework, we sought to identify patient characteristics and treatment response associated with superior clinical outcomes.
A retrospective cohort study of specialty buprenorphine treatment patients entering treatment (n=19,487) based on EHR records from a large multi-state buprenorphine treatment network (2011-2019). Person-level care episodes were evaluated across treatment intake, engagement (i.e. 2+ visits in the month following intake), and retention at 6, 12, and 24 months. Time to achieving 90 days of continuous opioid abstinence was assessed using Cox proportional hazards regressions models and also assessed as a predictor of long-term retention.
Most patients engaged (82.4 %), but retention steadily declined over 6-month (38.7 %), 12-month (26.2 %), and 24-month (17.1 %) timepoints. Opioid-positive baseline tests were associated with lower hazards of achieving continuous abstinence for both buprenorphine-positive (aHR=0.33, p<.001) and buprenorphine-negative (aHR=0.49,p<.001) intakes. Opioid abstinence was associated with buprenorphine-positive baseline testing (aHR=1.59,p<.001), especially for those testing opioid-negative (aHR=1.82,p<.001). Patients who achieved and sustained abstinence at 6 months in care were 4.1 and 5.5 times as likely to achieve 12-month and 24-month retention, respectively, compared to patients with intermittent opioid use.
Treatment discontinuation was concentrated early in care and buprenorphine and opioid status at intake were prognostic of achieving and sustaining abstinence. Early abstinence was associated with higher likelihood of subsequent stage progression. Implementing interventions to support early clinical stability for high-risk patients is critical to improve clinical outcomes.
在阿片类药物使用障碍（OUD）患者的丁丙诺啡治疗中，参与和保留方面的挑战破坏了治疗效果。根据 OUD 照护级联框架，我们试图确定与更好临床结局相关的患者特征和治疗反应。
这是一项回顾性队列研究，纳入了来自一个大型多州丁丙诺啡治疗网络（2011-2019 年）电子健康记录的专科丁丙诺啡治疗患者（n=19487）。在治疗摄入时、参与（摄入后一个月内就诊 2 次以上）以及 6、12 和 24 个月的保留方面，对个人层面的护理事件进行了评估。使用 Cox 比例风险回归模型评估实现 90 天连续阿片类药物戒断的时间，并评估其作为长期保留的预测指标。
大多数患者参与（82.4％），但保留率在 6 个月（38.7％）、12 个月（26.2％）和 24 个月（17.1％）时逐渐下降。基线阿片类药物阳性检测与丁丙诺啡阳性（aHR=0.33，p<.001）和丁丙诺啡阴性（aHR=0.49，p<.001）摄入时实现连续戒断的风险较低有关。阿片类药物戒断与丁丙诺啡阳性基线检测相关（aHR=1.59，p<.001），尤其是对那些检测为阿片类药物阴性的患者（aHR=1.82，p<.001）。在治疗中实现并维持 6 个月戒断的患者，与间歇性使用阿片类药物的患者相比，12 个月和 24 个月的保留率分别提高了 4.1 倍和 5.5 倍。
治疗中断集中在早期，摄入时的丁丙诺啡和阿片类药物状态是实现和维持戒断的预后因素。早期戒断与随后阶段进展的可能性更高相关。实施干预措施，为高风险患者提供早期临床稳定支持，对于改善临床结局至关重要。
