Predictors of availability of long-acting medication for opioid use disorder
Predictors of availability of long-acting medication for opioid use disorder
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DOI：
10.1016/j.drugalcdep.2019.107586
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发表时间：
2019-11-01
影响因子：
4.2
通讯作者：
Humphreys, Keith
中科院分区：
文献类型：
--
作者：
Shover, Chelsea L.;Humphreys, Keith
背景：美国食品和药物管理局(FDA)已经批准了三种治疗阿片类药物使用障碍(Moud)的长效药物：2010年的缓释纳曲酮(XR-NTX)，2016年的丁丙诺啡皮下埋植剂，以及2017年的库丁丙诺啡注射剂。长效Moud选项可能会在减少转移的同时提高依从性，但与每日剂量Moud相比，它们的可用性尚未得到很好的表征。这项分析的目的是描述长效Moud在美国药物使用障碍治疗环境中的可用性。方法：利用2017年全国药物滥用治疗服务调查(N-SSATS)和州一级阿片类药物过量死亡率，我们检查了州和设施层面因素和提供长效Moud之间的关联，包括XR-NTX和丁丙诺啡植入物。结果：在全国范围内，38%(n=5141)的戒毒机构提供了任何一种长效MOD(每日或长效)。其中，62%提供XR-NTX，而只有3%提供丁丙诺啡植入物。中东部、中南部、中西部和山区的设施提供XR-NTX的几率较高，联邦资助的设施和阿片类药物过量死亡率最高的州的设施也是如此。结论：2017年，提供Moud的少数设施中大部分提供XR-NTX，但丁丙诺啡植入物没有。增加Moud的可获得性，包括长效选择，对于解决阿片类药物使用障碍治疗未得到满足的需求是必要的。
Background: The U.S. Food and Drug Administration has approved three long-acting medications for opioid use disorder (MOUD): extended-release naltrexone (XR-NTX) in 2010, a subdermal buprenorphine implant in 2016, and a depot buprenorphine injection in 2017. Long-acting MOUD options may improve adherence while reducing diversion, but their availability compared to daily-dosing MOUD has not been well-characterized. The objective of this analysis was to characterize the availability of long-acting MOUD in substance use disorder treatment settings in the United States.Methods: Using the 2017 National Survey on Substance Abuse Treatment Services (N-SSATS) and state-level opioid overdose mortality, we examined associations between state- and facility-level factors and offering long-acting MOUD, which included XR-NTX and the buprenorphine implant. We constructed multivariable mixed logistic regression models for both types of long-acting MOUD.Results: Nationwide, 38% (n = 5141) of substance use treatment facilities provided any kind of MOUD (daily or long-acting). Of these, 62% provided XR-NTX, whereas only 3% offered the buprenorphine implant. Facilities in the East North Central, East South Central, West North Central and Mountain regions had higher odds of offering XR-NTX, as did federally-funded facilities, and facilities in states with the highest opioid overdose mortality rates.Conclusions: In 2017, XR-NTX was available at most of the minority of facilities offering MOUD, but the buprenorphine implant was not. Increasing the availability of MOUD, including long-acting options, is necessary to address unmet need for opioid use disorder treatment.