Buprenorphine and Substance Abuse Services for Prescription Opioid Dependence

丁丙诺啡和针对处方阿片类药物依赖的药物滥用服务

• 批准号: 8614727
• 负责人: CYNTHIA I CAMPBELL
• 金额: $ 54.39万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8614727
• 关键词: Abstinence; Accident and Emergency department; Address; Adherence; Admission activity; Adoption; Adult; Affect; Alcohol abuse; Alcohol or Other Drugs use; Behavior Therapy; Behavioral; Buprenorphine; Caring; Centers for Disease Control and Prevention (U.S.); Clinical Trials Network; Communities; Comorbidity; Complex; Computerized Medical Record; Crime; Data; Dose; Drug Formulations; Drug abuse; Epidemic; Health; Health Information System; Health Services; Health system; Healthcare; High Prevalence; Individual; Influentials; Inpatients; Interview; Knowledge; Lead; Mediating; Medical; Medication Management; Modality; Modeling; Mono-S; Naloxone; National Institute of Drug Abuse; Opiate Addiction; Opioid; Outcome; Outpatients; Overdose; Patient Self-Report; Patients; Pharmaceutical Preparations; Prevention; Primary Health Care; Psychosocial Assessment and Care; Quality of life; Randomized; Recruitment Activity; Relapse; Reporting; Research; Risk; Services; Severities; Societies; Substance abuse problem; Telephone; Testing; Treatment outcome; Visit; Work; arm; base; behavioral clinical trial; buprenorphine abuse; compliance behavior; cost; cost effectiveness; design; disorder later incidence prevention; dual diagnosis; effective therapy; follow-up; health economics; improved; innovation; medical specialties; opioid abuse; overdose death; patient population; prescription opioid; public health relevance; randomized trial; service intervention; standard care; tobacco abuse; treatment effect; treatment program

ABSTRACT Prescription opioid dependence affects 1.9 million in the U.S, with a 400% increase in treatment admissions in recent years, and more than 15,500 fatal overdoses a year. Buprenorphine/naloxone (BUP/NX) is an effective treatment for prescription opioid dependence, with longer adherence to the medication leading to a lower risk of opioid relapse. Yet adherence can be low, and behavioral services remain a critical part of treatment. This study addresses gaps in knowledge about the behavioral services needed to optimize BUP/NX adherence and substance use (SU) outcomes in the treatment of prescription opioid dependence. We propose a randomized trial of two group-based models of care for BUP/NX patients in SU specialty treatment: Standard Medical Management (SMM) and Intensive Outpatient Treatment (IOT). There is little evidence on what level of behavioral services can support BUP/NX adherence and improve outcomes, particularly for complex patients with medical and psychiatric comorbidities who present to specialty treatment. The proposed study addresses these important issues, responding to PA-12-237, "Health Services and Economic Research on the Prevention and Treatment of Drug, Alcohol, and Tobacco Abuse (R01)." The setting is a large outpatient SU specialty treatment program, where these models of care have not been empirically tested with BUP/NX patients, and where a high prevalence of patients with co-occurring psychiatric and medical comorbidities are treated. SSM includes brief weekly group-based visits consistent with previously studied medical models, and is drawn from primary care BUP/NX research. IOT is a predominant model of care in specialty treatment, and incorporates psychosocial support, 12-step, educational and relapse-prevention based approaches. We will recruit 600 adult patients inducted onto BUP/NX, randomize them to either SMM or IOT, and conduct telephone follow-up interviews at 6 and 12 months. We will examine the impact of these treatment approaches on 90-day BUP/NX adherence, opioid abstinence and reductions in use, other SU, quality of life, and health care and societal costs. Further, we will examine whether the effect of IOT versus SMM on adherence and SU treatment outcomes is greater for those with medical or psychiatric comorbidities. Our innovative approach includes a focus on complex patients with psychiatric and medical comorbidities in specialty care, adapting a care model previously only tested in primary care, a 12-month follow-up, no research-forced medication taper, an examination of health care and societal costs, and a combination of patient self-report and electronic medical record data Through this approach, the proposed study will yield critically important findings on how best to treat complex prescription opioid dependent patients, a growing patient population, with an integrative behavioral services and medication treatment model in SU treatment.

摘要