Treating homeless opioid dependent patients with buprenorphine in an office-based setting
Treating homeless opioid dependent patients with buprenorphine in an office-based setting
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DOI：
10.1007/s11606-006-0023-1
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发表时间：
2007-02-01
影响因子：
5.7
通讯作者：
Samet, Jeffrey H.
中科院分区：
文献类型：
--
作者：
Alford, Daniel P.;LaBelle, Colleen T.;Samet, Jeffrey H.
背景：虽然办公室为基础的阿片类药物治疗与丁丙诺啡（OBOT-B）已成功地实施了在初级保健设置在美国，其使用尚未报告在无家可归的patients.Objective：描述的可行性OBOT-B在无家可归的相对住房患者。设计：一项回顾性记录审查，检查治疗失败、药物使用、药物滥用治疗服务的利用，2003年8月至2004年10月期间，在OBOT-B计划中，由护士护理经理（NCM）在无家可归和住院患者中提供临床支持的强度。治疗失败定义为在完成药物诱导前私奔、在药物诱导后因持续用药与强化治疗同时不依从而出院、或因破坏性行为而出院。在44名无家可归者和41名居住在12个月以上的患者中，无家可归者更有可能是老年人，非白人，失业，感染艾滋病毒和丙型肝炎，并报告精神疾病。无家可归的患者有更少的社会支持和更多的慢性药物滥用史，3至6倍的吸毒年数，戒毒尝试次数和美沙酮维持治疗史的百分比。无家可归者（21%）和居住者（22%）治疗失败的受试者比例没有差异（P= 0.94）。在12个月时，两组的非法阿片类药物使用比例相似[比值比（OR），0.9（95% CI，0.5-1.7）P=.8]，咨询利用率（无家可归者，46%;居住，49%; P=.95），参与互助组（无家可归者，25%;居住，29%; P=.96）。12个月后，36%的无家可归者不再无家可归。在治疗的第一个月，无家可归的病人需要更多的临床支持，从NCM比住房的病人。尽管无家可归的阿片类药物依赖患者的社会不稳定性，更大的合并症和更多的慢性药物使用，但在该人群中有效实施了基于办公室的丁丙诺啡阿片类药物治疗，与住院患者在治疗失败，非法阿片类药物使用，和药物滥用治疗的使用。
CONTEXT: Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients.OBJECTIVE: To characterize the feasibility of OBOT-B in homeless relative to housed patients.DESIGN: A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior.RESULTS: Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P=.94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5-1.7) P=.8], utilization of counseling (homeless, 46%; housed, 49%; P=.95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P=.96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients.CONCLUSIONS: Despite homeless opioid dependent patients' social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment.