Non-prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder.
Non-prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder.
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DOI：
10.1016/j.jsat.2022.108770
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发表时间：
2022-08
影响因子：
3.9
通讯作者：
Chiodo, Lisa
中科院分区：
文献类型：
--
作者：
Williams, Arthur Robin;Mauro, Christine M.;Feng, Tianshu;Wilson, Amanda;Cruz, Angelo;Olfson, Mark;Crystal, Stephen;Samples, Hillary;Chiodo, Lisa
成功保留丁丙诺啡可改善阿片类药物使用障碍（OUD）的结局;然而，我们对治疗前使用非处方丁丙诺啡（NPB）与临床结局之间的相关性知之甚少。该研究对来自多个州的全国性办公室阿片类药物治疗计划的抽象电子健康记录（EHR）数据进行了观察性回顾性分析。该研究观察了1，000名新入院的OUD患者的随机样本，用于丁丙诺啡维持治疗（2015-2018），在摄入后长达12个月。我们通过强制性摄入药物测试和手动EHR编码来衡量NPB的使用。结果包括治疗中止的危险和阿片类药物使用率。与摄入时丁丙诺啡检测阴性的患者相比，检测阳性的患者（59.6%）治疗中止的风险较低（HR=0.52，95% CI：0.44，0.60，p<0.01）。在调整基线阿片类药物使用和其他患者特征后，结果几乎没有变化（aHR：0.60，95% CI：0.51，0.70，p<0.01）。不同丁丙诺啡来源的患者之间停药风险无显着差异：入院时处方与NPB（参考）（HR=1.15，95%CI：0.90，1.46）。丁丙诺啡阳性组在入院时（25.0% vs. 53.1%，p<0.0001）和整个治疗前几个月的阿片类药物使用率较低，但在7个月后，仍在接受治疗的患者阿片类药物使用率趋于一致（17.1% vs. 16.5%，p=0.89）。治疗前服用NPB与治疗中止的风险降低和阿片类药物使用减少相关。这些研究结果表明，使用NPB可能是治疗准备就绪的标志物，并且摄入时的丁丙诺啡测试可能对有关早期治疗中止风险的临床评估具有预测价值。
Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non–prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1,000 newly admitted patients with OUD for buprenorphine maintenance (2015–2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding. Outcomes included hazards of treatment discontinuation and rates of opioid use. Compared to patients testing negative for buprenorphine at intake, those testing positive (59.6%) had lower hazards of treatment discontinuation (HR=0.52, 95% CI: 0.44, 0.60, p<0.01). Results were little changed following adjustment for baseline opioid use and other patient characteristics (aHR: 0.60, 95% CI: 0.51, 0.70, p<0.01). Risk of discontinuation did not significantly differ between patients by buprenorphine source: prescribed v. NPB (reference) at admission (HR=1.15, 95% CI: 0.90, 1.46). Opioid use was lower in the buprenorphine positive group at admission (25.0% vs. 53.1%, p<0.0001) and throughout early months of treatment but converged after 7 months for those remaining in care (17.1% vs. 16.5%, p=0.89). NPB preceding treatment intake was associated with decreased hazards of treatment discontinuation and lower opioid use. These findings suggest use of NPB may be a marker of treatment readiness and that buprenorphine testing at intake may have predictive value for clinical assessments regarding risk of early treatment discontinuation.
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