Banta-Green Caleb J, Owens Mandy D, Williams Jason R, Floyd Anthony S, Williams-Gilbert Wendy, Kingston Susan
Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington Seattle, Seattle, WA, USA.
Department of Health Systems and Population Health, School of Public Health, University of Washington Seattle, Seattle, WA, USA.
Subst Abuse Rehabil. 2024 Sep 14;15:173-183. doi: 10.2147/SAR.S475807. eCollection 2024.
A large treatment gap exists for people who could benefit from medications for opioid use disorder (MOUD). People OUD accessing services in harm reduction and community-based organizations often have difficulty engaging in MOUD at opioid treatment programs and traditional health care settings. We conducted a study to test the impacts of a community-based medications first model of care in six Washington (WA) State communities that provided drop-in MOUD access.
Participants included people newly prescribed MOUD. Settings included harm reduction and homeless services programs. A prospective cohort analysis tested the impacts of the intervention on MOUD and care utilization. Intervention impacts on mortality were tested via a synthetic comparison group analysis matching on demographics, MOUD history, and geography using WA State agency administrative data.
825 people were enrolled in the study of whom 813 were matched to state records for care utilization and outcomes. Cohort analyses indicated significant increases for days' supply of buprenorphine, months with any MOUD, and months with any buprenorphine for people previously on buprenorphine (all results p<0.05). Months with an emergency department overdose did not change. Months with an inpatient hospital stay increased (p<0.05). The annual death rate in the first year for the intervention group was 0.45% (3 out of 664) versus 2.2% (222 out of 9893) in the comparison group in the 12 months; a relative risk of 0.323 (95% CI 0.11-0.94).
Findings indicated a significant increase in MOUD for the intervention group and a lower mortality rate relative to the comparison group. The COVID-19 epidemic and rapid increase in non-pharmaceutical-fentanyl may have lessened the intervention impact as measured in the cohort analysis. Study findings support expanding access to a third model of low barrier MOUD care alongside opioid treatment programs and traditional health care settings.
对于那些可从阿片类药物使用障碍药物治疗（MOUD）中获益的人群，存在巨大的治疗差距。在减少伤害及社区组织中获取服务的阿片类药物使用障碍患者，在阿片类药物治疗项目和传统医疗环境中参与MOUD治疗时往往存在困难。我们开展了一项研究，以测试在华盛顿州6个社区中提供即时MOUD服务的基于社区的药物优先护理模式的影响。
参与者包括新开具MOUD处方的人群。研究场所包括减少伤害及无家可归者服务项目。一项前瞻性队列分析测试了该干预措施对MOUD及医疗服务利用的影响。通过使用华盛顿州机构行政数据，对人口统计学、MOUD病史及地理位置进行匹配的合成对照组分析，测试干预措施对死亡率的影响。
825人参与了该研究，其中813人与州记录进行了匹配，以获取医疗服务利用情况及结果。队列分析表明，对于之前使用丁丙诺啡的人群，丁丙诺啡的供应天数、接受任何MOUD治疗的月数以及接受任何丁丙诺啡治疗的月数均显著增加（所有结果p<0.05）。因过量用药前往急诊科的月数未发生变化。住院天数增加（p<0.05）。干预组第一年的年死亡率为0.45%（664人中3人），而对照组在12个月内的死亡率为2.2%（9893人中222人）；相对风险为0.323（95%置信区间0.11 - 0.94）。
研究结果表明干预组的MOUD显著增加，且相对于对照组死亡率更低。在队列分析中所衡量的，2019冠状病毒病疫情及非药用芬太尼的迅速增加可能削弱了干预效果。研究结果支持在阿片类药物治疗项目和传统医疗环境之外，扩大获取低门槛MOUD护理第三种模式的机会。
