Prescribing decisions at buprenorphine treatment initiation: Do they matter for treatment discontinuation and adverse opioid-related events?
Prescribing decisions at buprenorphine treatment initiation: Do they matter for treatment discontinuation and adverse opioid-related events?
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DOI：
10.1016/j.jsat.2019.07.010
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发表时间：
2019-10-01
影响因子：
3.9
通讯作者：
Bao, Yuhua
中科院分区：
文献类型：
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作者：
Meinhofer, Angelica;Williams, Arthur Robin;Bao, Yuhua
引言。丁丙诺啡是一种治疗阿片类物质使用障碍（OUD）的高效药物，可在多种治疗环境中使用。然而，治疗的持续性仍然是一个挑战。在本研究中，我们研究了初始丁丙诺啡处方的供应天数以及日剂量与丁丙诺啡开始使用后治疗中断和阿片类相关不良事件的关联。
方法：对2011年至2015年医疗保健成本研究所的商业保险索赔数据进行了分析，这些数据涉及18 - 64岁开始丁丙诺啡治疗的个体（N = 17158）。治疗中断定义为在开始治疗后的180天内丁丙诺啡使用间隔30天或更长时间。阿片类相关不良事件定义为在开始治疗后的360天内至少有一次因阿片类中毒、依赖或滥用而前往急诊科就诊或住院。我们进行了多变量逻辑回归，以估计与初始丁丙诺啡处方的日剂量（4毫克）和供应天数（= 28天）相关的结果的调整后比值比。
结果：超过一半（55%）的个体在180天内中断了丁丙诺啡治疗，13%的个体在开始治疗后的360天内经历了至少一次阿片类相关不良事件。较低的初始剂量[= 28天，比值比 = 1.22，p < 0.01]都与中断治疗的几率增加有关。虽然较低的初始剂量与不良事件无关，但较少的初始供应天数与较高的不良事件风险相关，即使在控制了治疗中断的情况下也是如此。
结论：在这群有商业保险的非老年成年人中，我们发现较少的初始供应天数以及较低的初始剂量与治疗中断的可能性增加有关，这凸显了在为阿片类物质使用障碍开始使用丁丙诺啡时处方决策的重要性。
Introduction. Buprenorphine is a highly effective medication treatment for opioid use disorder (OUD) that can be prescribed in multiple treatment settings. Treatment retention, however, remains a challenge. In this study, we examined the association of days of supply as well as daily dosage of the initial buprenorphine prescription with treatment discontinuation and adverse opioid-related events following buprenorphine initiation.Methods: 2011 to 2015 Health Care Cost Institute commercial claims data were analyzed for individuals aged 18-64 years initiating buprenorphine treatment (N = 17,158). Treatment discontinuation was defined as a gap of 30 days or more in buprenorphine use within 180 days of initiation. Adverse opioid-related events were defined as having at least one emergency department visit or inpatient admission involving opioid poisoning, dependence or abuse within 360 days of initiation. We conducted multivariate logistic regressions to estimate adjusted odds ratios of outcomes associated with daily dose (4 mg) and days of supply (= 28 days) of the initial buprenorphine prescription.Results: Over one-half (55%) of individuals discontinued buprenorphine within 180 days and 13% experienced at least one adverse opioid-related event within 360 days of initiation. Both a lower initial dose [= 28 days, OR = 1.22, p < 0.011 were associated with increased odds of discontinuation. While a lower initial dose was not associated with adverse events, fewer initial days of supply were associated with a higher risk of adverse events, even after controlling for treatment discontinuation.Conclusion: In this population of commercially insured, non-elderly adults, we found that fewer initial days of supply as well as a lower initial dose were associated with increased likelihood of treatment discontinuation, highlighting the importance of prescribing decisions when initiating buprenorphine for OUD.