Prior buprenorphine experience is associated with office-based buprenorphine treatment outcomes.
Prior buprenorphine experience is associated with office-based buprenorphine treatment outcomes.
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DOI：
10.1097/adm.0b013e31829727b2
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发表时间：
2013-07
影响因子：
5.5
通讯作者：
Sohler NL
中科院分区：
文献类型：
--
作者：
Cunningham CO;Roose RJ;Starrels JL;Giovanniello A;Sohler NL
随着丁丙诺啡治疗和非法丁丙诺啡使用的增加，许多寻求丁丙诺啡治疗的患者之前都有过丁丙诺啡的使用经验。几乎没有证据可以指导有丁丙诺啡使用经验的患者的最佳治疗策略。我们检查了先前的丁丙诺啡经验是否与治疗保留和阿片类药物的使用有关。我们还探讨了先前使用丁丙诺啡的类型（处方或非法使用）是否与这些治疗结果相关。我们分析了一项纵向队列研究的访谈和医疗记录数据，该研究涉及 87 名接受办公室丁丙诺啡治疗的个体。我们使用逻辑回归模型检查了先前的丁丙诺啡经验与 6 个月治疗保留之间的关联，并使用非线性混合模型检查了先前的丁丙诺啡经验与 1、3 和 6 个月时任何自我报告的阿片类药物使用之间的关联。大多数（57.4%）参与者报告了之前使用丁丙诺啡的经历；其中，40% 使用处方丁丙诺啡，60% 仅使用非法丁丙诺啡。与未使用过丁丙诺啡的参与者相比，有过丁丙诺啡使用经验的参与者具有更好的治疗保留率（AOR=2.65，95% CI=1.05-6.70）。在探索丁丙诺啡的处方和非法使用时，也发现了类似的关联，但并未达到显着性。将具有丁丙诺啡使用经验的参与者与未使用过丁丙诺啡的参与者进行比较时，阿片类药物的使用没有差异（AOR=1.33，95% CI=0.38-4.65）。尽管不显着，但在按既往丁丙诺啡使用类型探索阿片类药物使用时发现了质量上不同的结果（处方丁丙诺啡与未使用丁丙诺啡，AOR=2.20，95% CI=0.58–8.26；非法丁丙诺啡与未使用丁丙诺啡，AOR=0.47，95% CI=0.07–3.46）。之前使用丁丙诺啡的经历很常见，并且与更好的保留相关。了解先前的丁丙诺啡经验如何影响治疗结果具有重要的临床和公共卫生意义。
As buprenorphine treatment and illicit buprenorphine use increase, many patients seeking buprenorphine treatment will have had prior experience with buprenorphine. Little evidence is available to guide optimal treatment strategies for patients with prior buprenorphine experience. We examined whether prior buprenorphine experience was associated with treatment retention and opioid use. We also explored whether type of prior buprenorphine use (prescribed or illicit use) was associated with these treatment outcomes. We analyzed interview and medical record data from a longitudinal cohort study of 87 individuals who initiated office-based buprenorphine treatment. We examined associations between prior buprenorphine experience and 6-month treatment retention using logistic regression models, and prior buprenorphine experience and any self-reported opioid use at 1, 3, and 6 months using non-linear mixed models. Most (57.4%) participants reported prior buprenorphine experience; of these, 40% used prescribed buprenorphine and 60% illicit buprenorphine only. Compared to buprenorphine-naïve participants, those with prior buprenorphine experience had better treatment retention (AOR=2.65, 95% CI=1.05–6.70). Similar associations that did not reach significance were found when exploring prescribed and illicit buprenorphine use. There was no difference in opioid use when comparing participants with prior buprenorphine experience to those who were buprenorphine-naive (AOR=1.33, 95% CI=0.38–4.65). Although not significant, qualitatively different results were found when exploring opioid use by type of prior buprenorphine use (prescribed buprenorphine vs. buprenorphine-naïve, AOR=2.20, 95% CI=0.58–8.26; illicit buprenorphine vs. buprenorphine-naïve, AOR=0.47, 95% CI=0.07–3.46). Prior buprenorphine experience was common and associated with better retention. Understanding how prior buprenorphine experience affects treatment outcomes has important clinical and public health implications.