Perceptions and practices addressing diversion among US buprenorphine prescribers
Perceptions and practices addressing diversion among US buprenorphine prescribers
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DOI：
10.1016/j.drugalcdep.2018.01.015
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发表时间：
2018-05-01
影响因子：
4.2
通讯作者：
Knudsen, Hannah K.
中科院分区：
文献类型：
--
作者：
Lin, Lewei (Allison);Lofwall, Michelle R.;Knudsen, Hannah K.
背景资料：虽然在美国，丁丙诺啡用于治疗阿片类药物使用障碍的处方量急剧增加，但关于处方者对丁丙诺啡转移的态度和做法以及它们与处方者特征的关系却知之甚少。方法：全国随机抽样的丁丙诺啡处方者（N = 1174）从2014年7月至2017年1月完成了调查。分析研究处方和实践特点和处方的看法和方法之间的关系，关于diversion.Results：在这个样本的丁丙诺啡处方，79.0%（N = 898）报告评估所有患者的丁丙诺啡转移和滥用的风险。三分之一的处方者将药物转移描述为他们社区的一个重大或非常重大的问题。大多数处方医生报告在治疗的前60天内平均至少每隔一周见一次患者，大多数处方医生报告检测尿液中的丁丙诺啡以评估药物转移。认为分流是他们社区的一个更大的问题（AOR 1.212，95% CI 1.073-1.369）和药物使用计数（AOR 1.006，95% CI 1.003-1.009）与怀疑转移时终止患者的可能性增加相关，同时具有成瘾方面的专业知识（AOR 0.526，95% CI 0.406-0.682）或精神病学（AOR 0.714，95%CI 0.558-0.914）与因疑似分流而终止治疗的几率降低相关。丁丙诺啡处方者报告转移是一个重要问题，大多数处方者报告说，他们评估患者的转移，尽管具体的实践基于开处方者和实践特征而不同。
Background: While there has been a dramatic increase in prescribing of buprenorphine for the treatment of opioid use disorder in the US, little is known about prescribers' attitudes and practices regarding buprenorphine diversion and how they relate to prescriber characteristics.Methods: A national random sample of buprenorphine prescribers (N = 1174) completed surveys from July 2014 to January 2017. Analyses examined relationships between prescriber and practice characteristics and prescriber perceptions and approaches regarding diversion.Results: Among this sample of buprenorphine prescribers, 79.0% (N = 898) reported assessing all patients for risk of buprenorphine diversion and misuse. A third of prescribers described diversion as a significant or very significant concern in their community. The majority of prescribers reported seeing patients on average at least every other week during the first 60 days of treatment, and the majority reported testing urine for buprenorphine to assess for diversion. Perceptions of diversion being a greater problem in their community (AOR 1.212, 95% CI 1.073-1.369) and use of medication counts (AOR 1.006, 95% CI 1.003-1.009) were associated with increased likelihood of terminating patients when diversion was suspected, while having expertise in addiction (AOR 0.526, 95% CI 0.406-0.682) or psychiatry (AOR 0.714, 95% CI 0.558-0.914) were associated with decreased odds of terminating treatment for suspected diversion.Conclusions: Buprenorphine prescribers report diversion is an important issue, and most prescribers report that they assess patients for diversion, though specific practices differ based on prescriber and practice characteristics.