Initiating opioid agonist treatment for opioid use disorder nationally in the Veterans Health Administration: Who gets what?
Initiating opioid agonist treatment for opioid use disorder nationally in the Veterans Health Administration: Who gets what?
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DOI：
10.1080/08897077.2019.1640831
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发表时间：
2019-08-01
期刊：
影响因子：
3.5
通讯作者：
Rosenheck, Robert
中科院分区：
文献类型：
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作者：
Manhapra, Ajay;Stefanovics, Elina;Rosenheck, Robert
背景资料：尽管阿片类激动剂治疗（OAT）与丁丙诺啡和美沙酮治疗阿片类药物使用障碍（OUD）相关的实质性获益，但只有一小部分OUD患者开始OAT。缺乏关于OUD患者中OAT启动相关性的研究。研究方法：使用退伍军人健康管理局（VHA）的国家行政数据，我们确定了在2012财政年度（FY）开始OAT使用丁丙诺啡或美沙酮维持治疗（MMT）的退伍军人（FY的前60天后首次开丁丙诺啡处方或首次美沙酮门诊访视）和当年未接受OAT的退伍军人。采用多变量logistic回归模型，包括社会人口学特征、诊断、服务和精神药物使用变量，以确定OAT启动的独立预测因素。结果：年龄越大（以10岁为增量;比值比[OR]：0.96，95%置信区间[CI]：0.0.9-0.97）和黑人（OR：0.46，95% CI：0.38-0.55）与开始丁丙诺啡治疗的几率较低相关，但与开始MMT治疗无关。与没有OAT相比，患有可卡因和抗焦虑镇静催眠药使用障碍的退伍军人开始使用丁丙诺啡和美沙酮的几率更高。接受任何精神健康住院治疗与开始丁丙诺啡而不是美沙酮的几率较高相关。总体而言，我们无法确定与OAT启动相关的一组可靠的患者特征。结论：这项研究指出了一个严峻的现实，即在阿片类药物危机中，我们对OUD患者启动OAT的情况知之甚少。
Background: Despite substantial benefits associated with opioid agonist treatment (OAT) with buprenorphine and methadone for opioid use disorder (OUD), only a small proportion of patients with OUD initiate OAT. There is a lack of studies addressing the correlates of OAT initiation among patients with OUD. Methods: Using Veterans Health Administration (VHA) national administrative data, we identified veterans with OUD who started OAT with either buprenorphine or methadone maintenance treatment (MMT) in fiscal year (FY) 2012 (first prescription of buprenorphine or first methadone clinic visit after the first 60 days of FY) and those who received no OAT that year. Multivariate logistic regression models including sociodemographic characteristics, diagnoses, and service and psychotropic drug use variables were used to identify independent predictors of OAT initiation. Results: Greater age (10-year increments; odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.0.9-0.97) and black race (OR: 0.46, 95% CI: 0.38-0.55) were associated with lower odds of being started on buprenorphine compared with no OAT, but not with MMT initiation. Veterans with cocaine and anxiolytic-sedative hypnotic use disorders had higher odds of being started on both buprenorphine and methadone compared with no OAT. Receipt of any mental health inpatient treatment was associated with higher odds of being started on buprenorphine but not methadone. Overall, we were unable to identify a robust set of patient characteristics associated with initiation of OAT. Conclusion: This study points out the stark reality that in the middle of an opioid crisis, we have very little insight into which patients with OUD initiate OAT.