Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings
Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings
复制标题
在社区初级保健机构使用丁丙诺啡-纳洛酮治疗阿片类药物成瘾
DOI：
10.1370/afm.665
复制
发表时间：
2007-03-01
影响因子：
4.4
通讯作者：
Woolhandler, Steffle
中科院分区：
文献类型：
--
作者：
Mintzer, Ira L.;Eisenberg, Mark;Woolhandler, Steffle
目的：丁丙诺啡和纳洛酮联合治疗阿片类药物成瘾于2002年获得批准。这种治疗在非研究性临床环境中的疗效尚未得到研究。我们检查了丁丙诺啡-纳洛酮在初级保健机构治疗的有效性和实用性。方法：我们研究了99名连续在2个城市初级保健诊所接受丁丙诺啡-纳洛酮治疗阿片类药物依赖的患者的队列：一个以医院为基础的初级保健诊所和一个独立的社区卫生中心的初级保健诊所。主要结局指标是6个月时的清醒程度，由治疗医生根据定期尿液药物测试、频繁的身体检查和对患者药物使用情况的询问来判断。结果54%的患者在6个月时清醒。清醒度与护理地点、药物选择、社区贫困水平或丁丙诺啡-纳洛酮剂量之间无显著相关性。清醒程度与私人保险状况、年龄、治疗时间长短和参加自助会议有关。结论：在现场资源有限的非研究性初级保健机构中，阿片类药物成瘾患者可以得到安全有效的治疗。我们的研究结果表明，更多的患者应该在非专业环境中获得丁丙诺啡-纳洛酮治疗。
PURPOSE Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002. Efficacy of this treatment in nonresearch clinical settings has not been studied. We examined the efficacy and practicality of buprenorphine-naloxone treatment in primary care settings.METHODS We studied a cohort of 99 consecutive patients enrolled in buprenorphine-naloxone treatment for opioid dependence at 2 urban primary care practices: a hospital-based primary care clinic, and a primary care practice in a free-standing neighborhood health center. The primary outcome measure was sobriety at 6 months as judged by the treating physician based on periodic urine drug tests, as well as frequent physical examinations and questioning of the patients about substance use.RESULTS Fifty-four percent of patients were sober at 6 months. There was no significant correlation between sobriety and site of care, drug of choice, neighborhood poverty level, or dose of buprenorphine-naloxone. Sobriety was correlated with private insurance status, older age, length of treatment, and attending self-help meetings.CONCLUSIONS Opioid-addicted patients can be safely and effectively treated in nonresearch primary care settings with limited on-site resources. Our findings suggest that greater numbers of patients should have access to buprenorphine-naloxone treatment in nonspecialized settings.