Buprenorphine Treatment for Hospitalized, Opioid-Dependent Patients A Randomized Clinical Trial
Buprenorphine Treatment for Hospitalized, Opioid-Dependent Patients A Randomized Clinical Trial
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DOI：
10.1001/jamainternmed.2014.2556
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发表时间：
2014-08-01
影响因子：
39
通讯作者：
Stein, Michael
中科院分区：
文献类型：
--
作者：
Liebschutz, Jane M.;Crooks, Denise;Stein, Michael
重要性丁丙诺啡类阿片激动剂治疗(OAT)已经确定了在寻求成瘾治疗的人中治疗阿片依赖的有效性。然而，对于非治疗、住院患者的有效性尚不清楚。目的确定住院期间应用丁丙诺啡以及出院后与办公室使用丁丙诺啡燕麦片挂钩是否增加了办公室燕麦片的使用率，增加了对燕麦片的持续参与度，减少了住院后6个月非法阿片类药物的使用。在这些人中，369人不符合资格标准。共有145名符合条件的患者同意参加随机临床试验。在这些患者中，139人完成了基线访谈，并被分配到戒毒组(n=67)或联动组(n=72)。干预为期5天的丁丙诺啡戒毒方案或丁丙诺啡诱导、院内剂量稳定、出院后过渡到附属于医院初级保健诊所的维持性丁丙诺啡燕麦(关联)。主要结果和测量进入和持续接触丁丙诺啡燕麦片1、3和6个月(病历核实)和之前30天非法阿片类药物使用(自报)。结果在随访期间，关联参与者比戒毒组更有可能服用丁丙诺啡燕麦片(52例[72.2%]vs8例[11.9%]，P<；.001)。在6个月时，12名关联参与者(16.7%)和2名戒毒参与者(3.0%)接受丁丙诺啡燕麦片治疗(P=0.007)。与戒毒组的参与者相比，在意向治疗分析中，被随机分配到链接组的参与者在6个月访谈前的30天内报告的非法阿片类药物使用较少(发生率比0.60；95%CI，0.46-0.73；P<；.01)。结论与住院戒毒方案相比，启动并联系丁丙诺啡治疗是吸引未寻求成瘾治疗的内科住院患者的有效手段，并在住院后6个月减少非法阿片类药物的使用。然而，保持对治疗的投入仍然是一项挑战。
IMPORTANCE Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known. OBJECTIVE To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization.DESIGN, SETTING, AND PARTICIPANTS From August 1, 2009, through October 31, 2012, a total of 663 hospitalized, opioid-dependent patients in a general medical hospital were identified. Of these, 369 did not meet eligibility criteria. A total of 145 eligible patients consented to participation in the randomized clinical trial. Of these, 139 completed the baseline interview and were assigned to the detoxification (n = 67) or linkage (n = 72) group.INTERVENTIONS Five-day buprenorphine detoxification protocol or buprenorphine induction, intrahospital dose stabilization, and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital's primary care clinic (linkage).MAIN OUTCOMES AND MEASURES Entry and sustained engagement with buprenorphine OAT at 1, 3, and 6 months (medical record verified) and prior 30-day use of illicit opioids (self-report). RESULTS During follow-up, linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group (52 [72.2%] vs 8 [11.9%], P < .001). At 6 months, 12 linkage participants (16.7%) and 2 detoxification participants (3.0%) were receiving buprenorphine OAT (P = .007). Compared with those in the detoxification group, participants randomized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview (incidence rate ratio, 0.60; 95% CI, 0.46-0.73; P < .01) in an intent-to-treat analysis.CONCLUSIONS AND RELEVANCE Compared with an inpatient detoxification protocol, initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization. However, maintaining engagement in treatment remains a challenge.