Examining buprenorphine diversion through a harm reduction lens: an agent-based modeling study.
Examining buprenorphine diversion through a harm reduction lens: an agent-based modeling study.
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DOI：
10.1186/s12954-023-00888-6
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发表时间：
2023-10-17
影响因子：
4.4
通讯作者：
Bobashev G
中科院分区：
文献类型：
--
作者：
Adams JW;Duprey M;Khan S;Cance J;Rice DP;Bobashev G
最近的政策减少了对使用丁丙诺啡-纳洛酮（丁丙诺啡）治疗阿片类药物使用障碍 (OUD) 的限制。这些政策的批评者表达的主要担忧是丁丙诺啡转移的可能性。然而，丁丙诺啡转移增加对人口水平的影响尚不清楚。如果替代海洛因或芬太尼的使用，使用改用的丁丙诺啡可能具有保护作用。我们的研究目的是使用针对北卡罗来纳州校准的基于代理的模型来估计丁丙诺啡转移对阿片类药物过量的影响。我们模拟了五年内阿片类药物滥用和阿片类药物相关结果的进展。我们的现状假设是，50% 的丁丙诺啡处方者每周至少将一剂药物转移给其他 OUD 患者，10% 的 OUD 患者每周至少使用一次转移的丁丙诺啡。仅受控处方方案假设丁丙诺啡不会被转移，而增加转移方案假设 95% 的丁丙诺啡处方者被转移，50% 的 OUD 患者使用了转移的丁丙诺啡。我们假设当天使用改用的丁丙诺啡取代了其他阿片类药物的使用。敏感性分析增加了使用改用丁丙诺啡时过量的风险，增加了改用丁丙诺啡的使用频率，以及模拟未使用阿片类药物的个体使用改用丁丙诺啡。对五年内阿片类药物过量相关结果的情景进行了比较。我们的现状情景预测有 10,658 例（可信区间 [CI]：9699–11,679）例致命的阿片类药物过量。仅模拟丁丙诺啡受控处方（即无转移）的场景导致 10,741 例（9895–11,650）例阿片类药物过量死亡，而模拟增加转移的场景中则导致 10,301 例（9439–11,244）例死亡。与现状相比，仅使用受控处方的情况导致了相似数量的致命过量用药，而增加丁丙诺啡转移的情况导致致命过量用药减少了 357 例 (3.35%)。即使在使用转移的丁丙诺啡并纳入未使用阿片类药物的个体时增加过量风险，与没有丁丙诺啡转移的情况相比，增加转移也不会增加过量。在模型条件下，OUD 患者中丁丙诺啡转移率增加，阿片类药物过量发生的数量相似，但阿片类药物过量的非统计趋势较低。这些结果支持了现有的呼吁，即 OUD 患者能够低门槛或无障碍地获得丁丙诺啡。在线版本包含可在 10.1186/s12954-023-00888-6 获取的补充材料。
Recent policies have lessened restrictions around prescribing buprenorphine-naloxone (buprenorphine) for the treatment of opioid use disorder (OUD). The primary concern expressed by critics of these policies is the potential for buprenorphine diversion. However, the population-level effects of increased buprenorphine diversion are unclear. If replacing the use of heroin or fentanyl, use of diverted buprenorphine could be protective. Our study aim was to estimate the impact of buprenorphine diversion on opioid overdose using an agent-based model calibrated to North Carolina. We simulated the progression of opioid misuse and opioid-related outcomes over a 5-year period. Our status quo scenario assumed that 50% of those prescribed buprenorphine diverted at least one dose per week to other individuals with OUD and 10% of individuals with OUD used diverted buprenorphine at least once per week. A controlled prescription only scenario assumed that no buprenorphine would be diverted, while an increased diversion scenario assumed that 95% of those prescribed buprenorphine diverted and 50% of individuals with OUD used diverted buprenorphine. We assumed that use of diverted buprenorphine replaced the use of other opioids for that day. Sensitivity analyses increased the risk of overdose when using diverted buprenorphine, increased the frequency of diverted buprenorphine use, and simulated use of diverted buprenorphine by opioid-naïve individuals. Scenarios were compared on opioid overdose-related outcomes over the 5-year period. Our status quo scenario predicted 10,658 (credible interval [CI]: 9699–11,679) fatal opioid overdoses. A scenario simulating controlled prescription only of buprenorphine (i.e., no diversion) resulted in 10,741 (9895–11,650) fatal opioid overdoses versus 10,301 (9439–11,244) within a scenario simulating increased diversion. Compared to the status quo, the controlled prescription only scenario resulted in a similar number of fatal overdoses, while the scenario with increased diversion of buprenorphine resulted in 357 (3.35%) fewer fatal overdoses. Even when increasing overdose risk while using diverted buprenorphine and incorporating use by opioid naïve individuals, increased diversion did not increase overdoses compared to a scenario with no buprenorphine diversion. A similar number of opioid overdoses occurred under modeling conditions with increased rates of buprenorphine diversion among persons with OUD, with non-statistical trends toward lower opioid overdoses. These results support existing calls for low- to no-barrier access to buprenorphine for persons with OUD. The online version contains supplementary material available at 10.1186/s12954-023-00888-6.
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影响因子：
5.5
作者：
Carroll, Jennifer J.;Rich, Josiah D.;Green, Traci C.
通讯作者：
Green, Traci C.
影响因子：
39.2
作者：
Dunn, Kate M.;Saunders, Kathleen W.;Von Korff, Michael
通讯作者：
Von Korff, Michael
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R
影响因子：
2.5
作者：
Bishop-Freeman, Sandra C.;Friederich, Laura W.;Hudson, Jason S.
通讯作者：
Hudson, Jason S.
影响因子：
2.3
作者：
Johnson, Bjorn;Richert, Torkel
通讯作者：
Richert, Torkel