Individual and Health Policy Factors Associated With Positive Heroin and Opioid Treatment Response: United States, 2018.
Individual and Health Policy Factors Associated With Positive Heroin and Opioid Treatment Response: United States, 2018.
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与海洛因和阿片类药物积极治疗反应相关的个人和健康政策因素：美国，2018 年。
DOI：
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发表时间：
2022
影响因子：
12.7
通讯作者：
N. Zaller
中科院分区：
文献类型：
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作者：
George Pro;C. Hayes;Clare C. Brown;Johnathan H. Goree;N. Zaller
目标。确定在美国海洛因和阿片类药物治疗事件中与积极治疗反应相关的客户和州一级因素。方法。我们使用来自46个州的国家数据，使用治疗事件数据集-出院（2018年）来识别海洛因和阿片类药物治疗事件（n = 162 846）。我们将积极的治疗反应定义为入院和出院期间使用药物的减少。我们使用多变量回归，按种族/民族分层，以确定与积极治疗反应相关的人口统计学、疼痛相关和州级因素。结果。在所有种族/族裔群体中，较低的社区痛苦是更好的治疗结果的最强预测因子，特别是在白人和美国印第安人/阿拉斯加原住民中。原发性阿片类药物海洛因与白人和西班牙裔患者的预后较差有关。立法限制阿片类药物分配与西班牙裔发作的较好结果相关。丁丙诺啡的可用性与黑人发作的较好结果密切相关。结论。国家层面的变量，特别是社区困境，与客户层面的变量相比，与积极的治疗结果有更大的关联。公共卫生影响。改变州一级的政策和增加针对社区高度痛苦地区的资源，有可能改善阿片类药物使用障碍的治疗，并减少治疗结果的种族/民族差异。[J] .公共卫生杂志，2022;112(S1):S66-S76。https://doi.org/10.2105/AJPH.2021.306503)。
Objectives. To identify client- and state-level factors associated with positive treatment response among heroin and opioid treatment episodes in the United States. Methods. We used national data from 46 states using the Treatment Episode Dataset‒Discharges (2018) to identify heroin and opioid treatment episodes (n = 162 846). We defined positive treatment response as a decrease in use between admission and discharge. We used multivariable regression, stratified by race/ethnicity, to identify demographic, pain-related, and state-level factors associated with positive treatment response. Results. Lower community distress was the strongest predictor of better treatment outcomes across all racial/ethnic groups, particularly among White and American Indian/Alaska Native episodes. A primary opioid of heroin was associated with worse outcomes among White and Hispanic episodes. Legislation limiting opioid dispensing was associated with better outcomes among Hispanic episodes. Buprenorphine availability was strongly associated with better outcomes among Black episodes. Conclusions. State-level variables, particularly community distress, had greater associations with positive treatment outcomes than client-level variables. Public Health Implications. Changes in state-level policies and increased resources directed toward areas of high community distress have the potential to improve opioid use disorder treatment and reduce racial/ethnic disparities in treatment outcomes. (Am J Public Health. 2022;112(S1):S66-S76. https://doi.org/10.2105/AJPH.2021.306503).