Acute Care, Prescription Opioid Use, and Overdose Following Discontinuation of Long-Term Buprenorphine Treatment for Opioid Use Disorder
Acute Care, Prescription Opioid Use, and Overdose Following Discontinuation of Long-Term Buprenorphine Treatment for Opioid Use Disorder
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DOI：
10.1176/appi.ajp.2019.19060612
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发表时间：
2020-02-01
影响因子：
17.7
通讯作者：
Olfson, Mark
中科院分区：
文献类型：
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作者：
Williams, Arthur Robin;Samples, Hillary;Olfson, Mark
目的：虽然丁丙诺啡治疗降低了阿片类药物使用障碍中过量和死亡的风险，但大多数患者在几周或几个月内停止治疗。丁丙诺啡停药后的不良健康结果进行了比较，成功地保留超过6个月的连续治疗，最近通过的最低治疗时间由国家质量Forum.Methods：回顾性纵向队列分析进行了使用MarketScan多州医疗补助索赔数据库（2013年至2017年），每年覆盖12万受益人。样本包括连续接受丁丙诺啡≥ 180天的成人（18-64岁），分为保留6-9个月、9-12个月、12-15个月和15-18个月的队列。对于停药后阶段的结局评估，患者必须在丁丙诺啡停药后连续入组Medicaid 6个月。主要不良事件包括全因急诊就诊、全因住院、阿片类药物处方和药物过量（阿片类或非阿片类药物）。结果：所有队列中不良事件常见，近一半患者（42.1%-49.9%）至少在急诊就诊一次。与使用丁丙诺啡6-9个月的患者（N= 4，126）相比，使用丁丙诺啡15-18个月的患者（N=931）的急诊就诊率显著降低（比值比= 0.75，95% CI =0.65- 0.86），住院治疗（比值比= 0.79，95% CI = 0.64 - 0.99），以及在停药后6个月内填写阿片类药物处方（比值比=0.67，95% CI =0.56-0.80）。大约5%的患者在所有队列经历了一个或多个药物治疗overdoses.Conclusions：急性护理服务的使用和过量的风险高丁丙诺啡停药后，无论治疗时间。上级结局随着治疗持续时间超过15个月而变得显著，尽管主要不良结局的发生率仍然很高。
Objective: Although buprenorphine treatment reduces risk of overdose and death in opioid use disorder, most patients discontinue treatment within a few weeks or months. Adverse health outcomes following buprenorphine discontinuation were compared among patients who were successfully retained beyond 6 months of continuous treatment, a minimum treatment duration recently endorsed by the National Quality Forum.Methods: A retrospective longitudinal cohort analysis was performed using the MarketScan multistate Medicaid claims database (2013-2017), covering 12 million beneficiaries annually. The sample included adults (18-64 years of age) who received buprenorphine continuously for >= 180 days by cohorts retained for 6-9 months, 9-12 months,12-15 months, and 15-18 months. For outcome assessment in the post-discontinuation period, patients had to be continuously enrolled in Medicaid for 6 months after buprenorphine discontinuation. Primary adverse outcomes included all-cause emergency department visits, all-cause inpatient hospitalizations, opioid prescriptions, and drug overdose (opioid or non-opioid).Results: Adverse events were common across all cohorts, and almost half of patients (42.1% -49.9%) were seen in the emergency department at least once. Compared with patients retained on buprenorphine for 6-9 months (N=4,126), those retained for 15-18 months (N=931) had significantly lower odds of emergency department visits (odds ratio= 0.75, 95% CI =0.65- 0.86), inpatient hospitalizations (odds ratio= 0.79, 95% CI = 0.64 - 0.99), and filling opioid prescriptions (odds ratio=0.67, 95% 0=0.56-0.80) in the 6 months following discontinuation. Approximately 5% of patients across all cohorts experienced one or more medically treated overdoses.Conclusions: Risk of acute care service use and overdose were high following buprenorphine discontinuation irrespective of treatment duration. Superior outcomes became significant with treatment duration beyond 15 months, although rates of the primary adverse outcomes remained high.