Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention
Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention
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DOI：
10.1007/s11606-017-3993-2
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发表时间：
2017-06-01
影响因子：
5.7
通讯作者：
Fiellin, David A.
中科院分区：
文献类型：
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作者：
D'Onofrio, Gail;Chawarski, Marek C.;Fiellin, David A.
与仅转诊或转诊的短暂干预相比，急诊科（艾德）启动的丁丙诺啡/纳洛酮在初级保健中持续治疗可增加成瘾治疗的参与度，并在30天时减少非法阿片类药物的使用。在一项随机试验中，至少完成一次长期随访评估的患者队列中，共纳入290/329例患者（占随机样本的88%）。随后的队列与随机化样本没有显著差异。在研究进入时，在艾德中提供ED启动的丁丙诺啡，并在初级保健、转诊或短暂干预中持续10周。（2、6、12个月）;尿液毒理学丁丙诺啡组中更多的患者在2个月时进行成瘾治疗[68/92（74%），与转诊[42/79（53%），95% CI 42-64]和短期干预[39/83（47%），95% CI 37-58; p < 0.001]相比。在6个月[51/92（55%），95% CI 45-65; 46/70（66%）95% CI 54-76; 43/76（57%）95% CI 45-67; p = 0.37]或12个月[42/86（49%）95% CI 39-59; 37/73（51%）95% CI 39-62; 49/78（63%）95% CI 52-73; p = 0.16]。在2个月时，丁丙诺啡组报告的非法阿片类药物使用天数[1.1（95% CI 0.6-1.6）]少于转诊[1.8（95% CI 1.2-2.3）]和短暂干预[2.0（95% CI 1.5-2.6），p = 0.04]。在6个月或12个月时，未观察到非法阿片类药物使用的显著差异。在任何时候，HIV风险或阿片类药物阴性尿液结果的比率均无显著差异。ED启动的丁丙诺啡与在初级保健中继续使用丁丙诺啡的2个月间隔期间成瘾治疗的参与增加和非法阿片类药物使用减少相关。所有组的6个月和12个月结局相当。
Emergency department (ED)-initiated buprenorphine/naloxone with continuation in primary care was found to increase engagement in addiction treatment and reduce illicit opioid use at 30 days compared to referral only or a brief intervention with referral.To evaluate the long-term outcomes at 2, 6 and 12 months following ED interventions.Evaluation of treatment engagement, drug use, and HIV risk among a cohort of patients from a randomized trial who completed at least one long-term follow-up assessment.A total of 290/329 patients (88% of the randomized sample) were included. The followed cohort did not differ significantly from the randomized sample.ED-initiated buprenorphine with 10-week continuation in primary care, referral, or brief intervention were provided in the ED at study entry.Self-reported engagement in formal addiction treatment, days of illicit opioid use, and HIV risk (2, 6, 12 months); urine toxicology (2, 6 months).A greater number of patients in the buprenorphine group were engaged in addiction treatment at 2 months [68/92 (74%), 95% CI 65-83] compared with referral [42/79 (53%), 95% CI 42-64] and brief intervention [39/83 (47%), 95% CI 37-58; p < 0.001]. The differences were not significant at 6 months [51/92 (55%), 95% CI 45-65; 46/70 (66%) 95% CI 54-76; 43/76 (57%) 95% CI 45-67; p = 0.37] or 12 months [42/86 (49%) 95% CI 39-59; 37/73 (51%) 95% CI 39-62; 49/78 (63%) 95% CI 52-73; p = 0.16]. At 2 months, the buprenorphine group reported fewer days of illicit opioid use [1.1 (95% CI 0.6-1.6)] versus referral [1.8 (95% CI 1.2-2.3)] and brief intervention [2.0 (95% CI 1.5-2.6), p = 0.04]. No significant differences in illicit opioid use were observed at 6 or 12 months. There were no significant differences in HIV risk or rates of opioid-negative urine results at any time.ED-initiated buprenorphine was associated with increased engagement in addiction treatment and reduced illicit opioid use during the 2-month interval when buprenorphine was continued in primary care. Outcomes at 6 and 12 months were comparable across all groups.