Behavioral drug and HIV risk reduction counseling (BDRC) with abstinence-contingent take-home buprenorphine: A pilot randomized clinical trial
Behavioral drug and HIV risk reduction counseling (BDRC) with abstinence-contingent take-home buprenorphine: A pilot randomized clinical trial
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DOI：
10.1016/j.drugalcdep.2007.11.008
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发表时间：
2008-04-01
影响因子：
4.2
通讯作者：
Schottenfeld, R. S.
中科院分区：
文献类型：
--
作者：
Chawarski, M. C.;Mazlan, M.;Schottenfeld, R. S.
这项初步随机临床试验评估了在提供有限咨询或药物依从性监督的情况下，基于办公室的丁丙诺啡维持治疗（BMT）的疗效是否通过增加个体药物咨询和戒断相关的丁丙诺啡带回家剂量而得到改善。经过2周的丁丙诺啡和稳定期，海洛因依赖者（n = 24）在麻坡，马来西亚被随机分配到标准服务BMT（医生管理的建议和支持，以及每周一次的非应急药物领取）或强化服务（护士提供的手册指导的行为药物和艾滋病毒风险降低咨询（BDRC）和禁欲条件带回家丁丙诺啡（ACB），7天最大供应量）。结果包括保留，阿片类药物阴性尿检的比例，自我报告的药物使用和自我报告的HIV风险行为。12/12（100%）的增强服务参与者和11/12（92%）的标准服务参与者完成了整个方案。随着时间的推移，两组阿片类药物阴性尿检的比例均显著增加（p < 0.001），增强服务组的减少幅度明显更大（p < 0.05）;加强服务组的阿片类药物尿液毒理学测试呈阴性的总体比例较高（87% vs. 69%，p = 0.04）和更长的阿片类药物连续戒断时间（10.3周vs. 7.8周，p = 0.154）。两组在治疗期间都显著降低了艾滋病毒风险行为（p < 0.05），但强化服务和标准服务之间的差异（分别较基线水平降低26%和17%）在统计学上并不显著（p = 0.9）。手册指导的行为药物和艾滋病毒风险降低咨询和禁欲特遣队带回家丁丙诺啡似乎有希望增加以办公室为基础的BMT提供有限的药物咨询和药物监督的疗效。(C)2007爱思唯尔爱尔兰有限公司保留所有权利。
This pilot randomized clinical trial evaluated whether the efficacy of office-based buprenorphine maintenance treatment (BMT), provided with limited counseling or oversight of medication adherence is improved by the addition of individual drug counseling and abstinence-contingent take-home doses of buprenorphine. After a 2-week buprenorphine and stabilization period, heroin dependent individuals (n = 24) in Muar, Malaysia were randomly assigned to Standard Services BMT (physician administered advice and support, and weekly, non-contingent medication pick-up) or Enhanced Services (nurse-delivered manual-guided behavioral drug and HIV risk reduction counseling (BDRC) and abstinence-contingent take-home buprenorphine (ACB), 7 day supply maximum). Outcomes included retention, proportion of opioid-negative urine tests, self-reported drug use, and self-reported HIV risk behaviors. 12/12 (100%) of Enhanced Services and 11/12 (92%) of Standard Services participants completed the entire protocol. The proportion of opioid-negative urine tests increased significantly over time for both groups (p < 0.001), and the reductions were significantly greater in the Enhanced Services group (p < 0.05); Enhanced Services group achieved higher overall proportions of opiate negative urine toxicology tests (87% vs. 69%, p = 0.04) and longer periods of consecutive abstinence from opiates (10.3 weeks vs. 7.8 weeks, p = 0.154). Both groups significantly reduced HIV risk behaviors during treatment (p < 0.05), but the difference between Enhanced and Standard Services (26% vs. 17% reductions from the baseline levels, respectively) was not statistically significant (p = 0.9). Manual-guided behavioral drug and HIV risk reduction counseling and abstinence-contingent take-home buprenorphine appear promising for adding to the efficacy of office-based BMT provided with limited drug counseling and medication oversight. (C) 2007 Elsevier Ireland Ltd. All rights reserved.