Effects of access barriers and medication acceptability on buprenorphine-naloxone treatment utilization over 2 years: Results from a multisite randomized trial of adults with opioid use disorder
Effects of access barriers and medication acceptability on buprenorphine-naloxone treatment utilization over 2 years: Results from a multisite randomized trial of adults with opioid use disorder
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DOI：
10.1016/j.jsat.2019.08.002
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发表时间：
2019-11-01
影响因子：
3.9
通讯作者：
Hser, Yih-Ing
中科院分区：
文献类型：
--
作者：
Evans, Elizabeth A.;Yoo, Caroline;Hser, Yih-Ing
背景资料：全国范围的努力寻求通过增加获得阿片类药物使用障碍（OUD），特别是丁丙诺啡的药物来解决阿片类药物流行病。一个鲜为人知的挑战是，在接受丁丙诺啡治疗的OUD患者中，许多人没有坚持足够长的药物治疗以获得持续的益处。我们的目的是确定与丁丙诺啡治疗利用率随时间推移的因素。方法：我们使用随机截距建模，以确定与丁丙诺啡治疗利用率超过2年后，第一次随访789个人与OUD谁参加了丁丙诺啡相比，美沙酮的多站点随机临床试验的相关因素。关键预测因子是参与者的报告丁丙诺啡治疗的可及性和可接受性（在第一次随访评估）和他们的相互作用的影响，控制基线随机化状态，社会人口统计学，和其他covariates.Results：约9.3-11.2%的参与者使用丁丙诺啡治疗超过2年的后续。相互作用的影响表明，个人认为丁丙诺啡既方便和可接受的是最有可能使用丁丙诺啡在后续，控制其他因素。相比之下，认为丁丙诺啡不可接受的人最不可能使用丁丙诺啡，无论他们认为获得药物的程度如何。丁丙诺啡治疗利用率也呈负相关，与西班牙裔的种族，西海岸的情况下，和累积月接受美沙酮治疗和监禁在follow-up.Conclusions：从事更多的个人与OUD在长期治疗与丁丙诺啡，干预措施应针对丁丙诺啡治疗的可接受性，除了增加丁丙诺啡的访问，并定制努力，以满足弱势群体的需求。
Background: Nationwide efforts seek to address the opioid epidemic by increasing access to medications for opioid use disorder (OUD), particularly with buprenorphine. A poorly understood challenge is that among individuals with OUD who do receive buprenorphine, many do not adhere to the pharmacotherapy long enough to achieve sustained benefits. We aimed to identify factors associated with buprenorphine treatment utilization over time.Methods: We used random-intercept modeling to identify factors associated with buprenorphine treatment utilization over 2 years after first follow-up by 789 individuals with OUD who had participated in a multi-site randomized clinical trial of buprenorphine compared to methadone. Key predictors were participants' reports of buprenorphine treatment accessibility and acceptability (assessed at first follow-up) and their interaction effects, controlling for baseline randomization status, sociodemographics, and other covariates.Results: Approximately 9.3-11.2% of participants utilized buprenorphine treatment over the 2 years of follow-up. Interaction effects indicated that individuals who perceived buprenorphine to be both accessible and acceptable were most likely to use buprenorphine during follow-up, controlling for other factors. In contrast, individuals who perceived buprenorphine to be unacceptable were least likely to use buprenorphine, regardless the level of perceived access to the medication. Buprenorphine treatment utilization was also negatively associated with Hispanic ethnicity, West coast context, and cumulative months receiving methadone treatment and incarceration during follow-up.Conclusions: To engage more individuals with OUD in long-term treatment with buprenorphine, interventions should target buprenorphine treatment acceptability, in addition to increasing buprenorphine access, and tailor efforts to meet the needs of vulnerable populations.