The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible
The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible
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DOI：
10.1097/adm.0000000000000436
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发表时间：
2018-11-01
影响因子：
5.5
通讯作者：
Green, Traci C.
中科院分区：
文献类型：
--
作者：
Carroll, Jennifer J.;Rich, Josiah D.;Green, Traci C.
目的：丁丙诺啡/纳洛酮，阿片类药物使用障碍的循证治疗，有时被转用于非医疗用途。在罗得岛，阿片类药物使用的流行以及最近非法药物供应中芬太尼的流行正在推动过量死亡，这增加了对治疗的需求，并提出了关于转移药物在形成过量风险方面不断变化的作用的问题。方法：本研究考虑了来自2项罗得岛研究的数据（分别于2009年和2016年进行）使用非法或转移处方阿片类药物的人及其丁丙诺啡/纳洛酮转移模式。使用有针对性的抽样，使用阿片类药物的个人完成了一份关于其药物使用的简短问卷。在2016年的研究中，使用逻辑回归来确定与近期和终生使用转移药物的关联。结果：共有128名非医学使用阿片类药物的人参加了2016年的研究。其中，38%（n = 13）报告在过去2个月内转移使用丁丙诺啡/纳洛酮，与2009年观察到的模式相似（41%，n = 41）。使用转用药物的常见动机包括戒断症状的管理（40%，n = 35）和阿片类药物使用障碍的自我治疗（39%，n = 34）。很少有人报告使用“获得高”（12%，n = 4）。在过去12个月内寻求丁丙诺啡/纳洛酮治疗与在过去2个月内使用转移药物呈正相关（比值比= 5.14，95%置信区间= 1.0-26.5，P = 0.05）。这两项研究的参与者报告了2009年和2016年相同的护理障碍。结论：在非医疗使用阿片类药物的人群中，转移/丁丙诺啡的使用仍然很常见，这表明治疗能力严重短缺，无法获得现有服务。
Objectives: Buprenorphine/naloxone, an evidence-based treatment for opioid use disorder, is sometimes diverted for non-medical use. In Rhode Island, the prevalence of opioid use and, more recently, of fentanyl in the illicit drug supply is driving overdose fatalities, which increases the need for treatment and raises questions about the changing role of diverted medication in shaping overdose risk.Methods: This study considered data from 2 Rhode Island based studies (conducted in 2009 and 2016, respectively) of people who use illicit or diverted prescription opioids and their patterns of buprenorphine/naloxone diversion. Using targeted sampling, individuals who use opioids completed a brief questionnaire about their drug use. For the 2016 study, logistic regression was used to identify associations with recent and lifetime use of diverted medication.Results: A total of 128 individuals who use opioids non-medically participated in the 2016 study. Of these, 38% (n = 13) reported diverted buprenorphine/naloxone use in the past 2 months, similar to the pattern observed in 2009 (41%, n = 41). Common motivations for using diverted medication included the management of withdrawal symptoms (40%, n = 35) and self-treatment of opioid use disorder (39%, n = 34). Few reported using to "get high'' (12%, n = 4). Seeking buprenorphine/naloxone treatment in the previous 12 months was positively associated with using diverted medication in the past 2 months (odds ratio = 5.14, 95% confidence interval = 1.0-26.5, P = 0.05). Participants of both studies reported the same barriers to care in 2009 and 2016.Conclusion: The use of diverted/buprenorphine remains common among people who use opioids non-medically and indicates a severe shortage in treatment capacity and inaccessibility of existing services.