A longitudinal comparison of retention in buprenorphine and methadone treatment for opioid dependence in New South Wales, Australia
A longitudinal comparison of retention in buprenorphine and methadone treatment for opioid dependence in New South Wales, Australia
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DOI：
10.1111/add.12834
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发表时间：
2015-04-01
期刊：
影响因子：
6
通讯作者：
Degenhardt, Louisa
中科院分区：
文献类型：
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作者：
Burns, Lucy;Gisev, Natasa;Degenhardt, Louisa
背景和目的研究澳大利亚新南威尔士州（NSW）首次美沙酮和丁丙诺啡客户的特征以及与首次治疗风险相关的因素。设计阿片类药物替代治疗（OST）的治疗，法院，监护和死亡率数据的回顾性联系研究。澳大利亚新南威尔士第一次参加开放源码软件培训的学员（2001年8月至2010年12月）。客户的特点进行了检查。时间依赖性考克斯模型研究了与离开第一次治疗的风险相关的因素，人口统计学，犯罪学和治疗变量共同考虑。检查了药物与其他变量之间在离开治疗风险时的相互作用。结果有15600治疗进入者：7183（46%）开始丁丙诺啡，8417（54%）开始美沙酮;进入丁丙诺啡的比例随着时间的推移而增加。那些开始丁丙诺啡的人更频繁地更换药物，并且随后有更多的治疗事件。丁丙诺啡保留也较差。平均而言，44%的人在治疗中花费了3个月以上，而开始美沙酮治疗的人中有70%;然而，首次进入者的丁丙诺啡保留随着时间的推移而改善，而美沙酮保留没有。多变量考克斯模型表明，除了性别、年龄、治疗环境和犯罪学变量外，接受丁丙诺啡的患者在任何给定日期离开首次治疗事件的风险更大，并且取决于开始治疗的年份。任何人口统计学变量和接受的药物之间没有相互作用，这表明没有明确的证据表明任何特定的群体，每种药物可能更适合改善保留。结论：虽然在澳大利亚新南威尔士州，丁丙诺啡治疗的保留率有所提高，但开始美沙酮治疗的个体仍显示出较高的保留率。
Background and Aims To examine characteristics of first-time methadone and buprenorphine clients and factors associated with risk of leaving first treatment in New South Wales (NSW), Australia. Design Retrospective linkage study of opioid substitution therapy (OST) treatment, court, custody and mortality data. Setting NSW, Australia. Participants First-time OST entrants (August 2001-December 2010). Measurements Characteristics of clients were examined. Time-dependent Cox models examined factors associated with the risk of leaving first treatment, with demographic, criminographic and treatment variables jointly considered. Interactions between medication and other variables upon risk of leaving treatment were examined. Findings There were 15600 treatment entrants: 7183 (46%) commenced buprenorphine, 8417 (54%) commenced methadone; the proportion entering buprenorphine increased over time. Those starting buprenorphine switched medications more frequently and had more subsequent treatment episodes. Buprenorphine retention was also poorer. On average, 44% spent 3+ months in treatment compared with 70% of those commencing methadone; however, buprenorphine retention for first-time entrants improved over time, whereas methadone retention did not. Multivariable Cox models indicated that in addition to sex, age, treatment setting and criminographic variables, the risk of leaving a first treatment episode was greater on any given day for those receiving buprenorphine, and was dependent on the year treatment was initiated. There was no interaction between any demographic variables and medication received, suggesting no clear evidence of any particular groups for whom each medication might be better suited in terms of improving retention. Conclusions Although retention rates for buprenorphine treatment have improved in New South Wales, Australia, individuals starting methadone treatment still show higher retention rates.