A demonstration project implementing extended-release naltrexone in Los Angeles County
A demonstration project implementing extended-release naltrexone in Los Angeles County
复制标题
DOI：
10.1080/08897077.2015.1052868
复制
发表时间：
2016-01-02
期刊：
影响因子：
3.5
通讯作者：
Rawson, Richard A.
中科院分区：
文献类型：
--
作者：
Cousins, Sarah J.;Denering, Loretta;Rawson, Richard A.
背景：缓释纳曲酮 (XR-NTX) 是一种经美国食品和药物管理局 (FDA) 批准的药物，与较高的戒断率、减少的渴望和延迟使用复发有关。然而，关于 XR-NTX 在现实世界中实施的文献却很少。洛杉矶县公共卫生部与加州大学洛杉矶分校综合药物滥用计划合作开发了一个示范项目，以增加 XR-NTX 的使用率。本文介绍了该项目，以及有关扩展 XR-NTX 服务交付和患者使用的数据。方法：对 2010 年 4 月至 2013 年 7 月期间从洛杉矶县物质使用障碍 (SUD) 治疗机构接受 XR-NTX 的 609 名患者进行了人口统计、物质使用史、当前物质使用行为、健康相关变量和剂量记录的二次描述性数据分析。地理信息系统方法绘制了整个洛杉矶县 XR-NTX 转诊机构的分布。结果：在分析的 609 条记录中，大多数患者 (64%) 获得了超过 1 剂 XR-NTX。大多数 XR-NTX 患者报告有酒精使用障碍（71.9%；n = 438）。与一般洛杉矶县物质使用障碍患者相比，XR-NTX 接受者报告了更严重的物质使用史。最后，洛杉矶县 8 个服务规划区中 6 个的提供商访问了 XR-NTX。结论：这些发现反映出 XR-NTX 戒断率较高，平均剂量数量较低，与社区环境中假释或缓刑患者的类似示范项目相比。然而，这项研究表明，让治疗提供者在患有酒精或阿片类药物使用障碍的患者中使用 XR-NTX 是可行的。讨论了对未来研究和实施的几个影响。
Background: Extended-released naltrexone (XR-NTX) is a Food and Drug Administration (FDA)-approved medication associated with higher rates of abstinence, reduced cravings, and delayed relapse to use. However, there is a dearth of literature on real-world implementation of XR-NTX. The Los Angeles County Department of Public Health, in collaboration with UCLA Integrated Substance Abuse Programs, developed a demonstration project to inc`rease access to XR-NTX. This article describes that project, along with data on the expansion of XR-NTX service delivery and patient uptake. Methods: A secondary descriptive data analysis of demographics, substance use history, current substance use behaviors, health-related variables, and dosing records was conducted on 609 patients who received XR-NTX from Los Angeles County substance use disorder (SUD) treatment facilities from April 2010 through July 2013. A geographic information system approach mapped the distribution of XR-NTX-referring agencies across Los Angeles County. Results: Of the 609 records analyzed, a majority of patients (64%) obtained more than 1 dose of XR-NTX. Most XR-NTX patients reported alcohol use disorder (71.9%; n = 438). Compared with the general Los Angeles County substance use disorder patients, XR-NTX recipients reported more severe substance use histories. Finally, XR-NTX was accessed by providers in 6 of the 8 Service Planning Areas of Los Angeles County. Conclusions: These findings reflect a higher XR-NTX cessation rate and a lower average number of doses, in contrast to similar demonstration projects in community settings with patients on parole or probation. However, this study shows that it is feasible to engage treatment providers in the use XR-NTX among their patients with alcohol or opioid use disorders. Several implications for future research and implementation are discussed.