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Patient-Reported Outcomes, Experiences and Satisfaction with Weekly and Monthly Injectable Prolonged-Release Buprenorphine. 患者报告的每周和每月注射丁丙诺啡的结果、经验和满意度。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2020-11-02 eCollection Date: 2020-01-01 DOI: 10.2147/SAR.S266838
Graham Parsons, Cindy Ragbir, Oscar D'Agnone, Ayana Gibbs, Richard Littlewood, Bernadette Hard

Introduction: Prolonged-release buprenorphine (PRB), administered by weekly or monthly injection, for opioid dependence (OD) treatment offers the potential to address some limitations of oral therapy including stigma, difficulty in achieving consistent appropriate dosing, risk of diversion of medications, risk of overdose, and continuing use of other drugs. Patient-reported outcomes (PRO) and experiences are important in the evaluation of OD therapy success. This work aimed to document PRO during PRB therapy to guide future treatment decision-making.

Methods: Qualitative interviews were completed with people on PRB OD treatment. Twenty individuals from four treatment services in England and Wales were asked to participate. A structured interview was developed guided by a person with OD lived experience. Interviews were transcribed, coded and analyzed using iterative categorization.

Results: Fifteen of 20 individuals approached agreed to participate, and 14 completed interviews. The average age of participants was 42 (range 33-54) years, 13 males and 1 woman, the history of problematic opioid use was 14 years (3-25 years), time in treatment was 7 years (1-20 years), and duration on treatment with PRB was 4 months (range 1-8 months). Participants reported treatment experiences leading to coding of 277 unique comments: therapy effectiveness (77% indicated a benefit of, or satisfaction with, PRB therapy, 7% neutral/general, 16% indicated concern or questions about PRB therapy), convenience (81% benefit, 7% neutral/general, 12% concern), and overall satisfaction (81% benefit, 3% neutral/general, 16% concern). Reported benefits include cravings reduction of 10 (71%), self-care improvement of 10 (71%), relationships improvement of 9 (64%), resources management of 6 (43%), positive outlook on life of 12 (86%). Participants reported a range of positive personal experiences; challenges reported included temporary injection discomfort at treatment initiation.

Discussion: In this small, focused population, there was generally a positive level of treatment satisfaction with PRB. These experiences provide insights to explain potential treatment benefit to others and are useful in guiding therapy choices for others in the future.

长期释放丁丙诺啡(PRB),每周或每月注射,用于阿片类药物依赖(OD)治疗,提供了解决口服治疗的一些局限性的潜力,包括耻辱,难以达到一致的适当剂量,药物转移的风险,过量的风险,以及继续使用其他药物。患者报告的结果(PRO)和经验是评估OD治疗成功的重要因素。本研究旨在记录PRB治疗过程中的PRO,以指导未来的治疗决策。方法:采用质性访谈法对接受PRB OD治疗的患者进行访谈。来自英格兰和威尔士四家治疗机构的20人被要求参与。在一个有吸毒过量生活经历的人的指导下,进行了一次结构化的访谈。使用迭代分类对访谈进行转录、编码和分析。结果:20个人中有15人同意参与,14人完成了访谈。参与者的平均年龄为42岁(33-54岁),男性13名,女性1名,阿片类药物问题使用史14年(3-25年),治疗时间7年(1-20年),PRB治疗持续时间4个月(1- 8个月)。参与者报告的治疗经历导致277个独特评论的编码:治疗有效性(77%表示对PRB治疗有益或满意,7%中立/一般,16%表示对PRB治疗的关注或问题),便利性(81%受益,7%中立/一般,12%关注)和总体满意度(81%受益,3%中立/一般,16%关注)。报告的益处包括:渴望减少10人(71%),自我照顾改善10人(71%),人际关系改善9人(64%),资源管理改善6人(43%),积极人生观改善12人(86%)。参与者报告了一系列积极的个人经历;报告的挑战包括治疗开始时的暂时性注射不适。讨论:在这个小而集中的人群中,PRB的治疗满意度总体上是积极的。这些经验为解释其他人的潜在治疗益处提供了见解,并有助于指导未来其他人的治疗选择。
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引用次数: 12
Subgrouping University Students Based on Substance Use Pattern: A Latent Class Analysis. 基于物质使用模式的大学生亚分组:一个潜在类分析。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2020-10-19 eCollection Date: 2020-01-01 DOI: 10.2147/SAR.S253960
Mohammad Reza Karimirad, Sima Afrashteh, Ali Gholami, Saeid Hossein Oghli, Abbas Abbasi-Ghahramanloo, Leila Bordbar, Mostafa Salari

Purpose: High-risk behaviors are the main causes of death and disability among youth and adults. Entering university might cause students to go through their first-hand experience of using substances.

Aim: This study aimed to detect the subgroups of students based on substance use and assess the effects of religiosity and parental support as well as other related factors on the membership of students in each latent class.

Methods: Using a multistage sampling method, this cross-sectional study was conducted in 2016 in Hormozgan University of Medical Sciences (n=524). All students completed a self-report questionnaire. This questionnaire contained questions about substance use, religious beliefs and familial support. The questions of substance use were prepared using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). To analyze the data, PROC LCA statistical method was run in SAS9.2.

Results: Three latent classes were identified: 1) nonuser (87.5%), 2) tobacco and illicit drug user (8.7%) and 3) polydrug user (3.8%). Having extramarital sex in the last month (OR=28.29, 95% CI; 8.45-94.76), living alone (OR=4.29, 95% CI; 1.01-18.35) and having a higher score of familial support (OR=0.94, 95% CI; 0.89-0.98) were associated with the polydrug user class. Hookah smoking had the highest (11.1%) and non-medical methylphenidate use had the lowest (2.3%) prevalence among the participants of the study.

Conclusion: This study revealed that 12.5% of the students were either tobacco and illicit drug users or polydrug users. Thus, focusing on the religiosity and familial support may help design some preventive programs for this stratum of young adults.

目的:高危行为是青少年和成人死亡和残疾的主要原因。进入大学可能会使学生经历使用物质的第一手经验。目的:本研究旨在检测学生物质使用亚群,并评估宗教信仰、父母支持及其他相关因素对每个潜在类别学生成员的影响。方法:采用多阶段抽样方法,于2016年在霍尔木兹甘医科大学进行横断面研究(n=524)。所有学生都完成了一份自我报告问卷。这份调查表包含有关药物使用、宗教信仰和家庭支持的问题。药物使用的问题是使用世界卫生组织的酒精、吸烟和药物使用筛选试验(世卫组织协助)编制的。在SAS9.2软件中采用PROC LCA统计方法对数据进行分析。结果:确定了3个潜在类别:1)非吸毒者(87.5%),2)烟草和非法药物使用者(8.7%)和3)多种药物使用者(3.8%)。最近一个月有婚外性行为(OR=28.29, 95% CI;8.45-94.76),独居(OR=4.29, 95% CI;1.01-18.35),家庭支持得分较高(OR=0.94, 95% CI;0.89-0.98)与多药使用者相关。在研究参与者中,水烟吸烟的患病率最高(11.1%),非医疗用哌醋甲酯的患病率最低(2.3%)。结论:本研究显示12.5%的学生是烟草和非法药物使用者或多种药物使用者。因此,关注宗教信仰和家庭支持可能有助于为这一年轻人阶层设计一些预防方案。
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引用次数: 3
Sex Differences in Substance Use and Misuse: A Toxicology Investigators' Consortium (ToxIC) Registry Analysis. 物质使用和滥用的性别差异:毒理学调查协会(毒性)登记分析。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2020-09-29 eCollection Date: 2020-01-01 DOI: 10.2147/SAR.S263165
Gillian A Beauchamp, Jennifer L Carey, Mikayla B Hurwitz, Briana N Tully, Matthew D Cook, Robert D Cannon, Kenneth D Katz, Andrew L Koons, Hope Kincaid, Marna Rayl Greenberg

Background: Variations between male and female populations are previously reported in classes of harmfully used/misused drugs, severity of substance use disorder and risk of relapse. The aim of this study was to provide a review of bedside medical toxicologist managed, sex-specific poisonings in adults that present with harmful drug use/misuse.

Methods: ToxIC Registry cases ≥19 and ≤65 years old, with harmful drug use or misuse during the timeframe June 2010-December 2016, were studied. Demographics, primary agents of toxic exposure, administration route and complications were analyzed. Descriptive methods were used in the analysis.

Results: The database included 51,440 cases. Of these, 3426 cases were analyzed in which the primary reason for the encounter was harmful substance use/misuse. Females were found to harmfully use/misuse pharmaceutical drugs (N=806, 65.6%) more than nonpharmaceutical drugs (N=423, 34.4%). Males more frequently used nonpharmaceutical drugs (N=1189, 54.1%) than pharmaceutical drugs (1008, 45.9%). Analgesics were used by females (N= 215, 18.2%) and males (N=137, 6.6%). Sedative hypnotics were used by females (N=165, 14%) and males (N=160, 7.8%). Psychoactive agents were used by males (N=325, 15.8%) and females (N=67, 5.7%). Sympathomimetics were used by males (N=381, 18.5%) and females (N=151, 12.8%). The majority of both male and female participants, 1712 (57.9%), utilized an oral route of administration. However, 312 (16.5%) of males utilized inhalation vs 73 (6.8%) of females inhaled their substance.

Conclusion: There were sex-specific differences among patients evaluated for harmful substance use/misuse by toxicologists. Considering these differences in regards to management and preventive approaches may be indicated.

背景:男性和女性人群在有害使用/滥用药物类别、物质使用障碍严重程度和复发风险方面的差异先前有过报道。本研究的目的是对床边医学毒理学家管理的、因有害药物使用/滥用而导致的成人性别特异性中毒进行综述。方法:选取2010年6月至2016年12月期间毒性登记≥19岁,≤65岁,有有害药物使用或误用的病例。分析患者的人口统计学特征、主要中毒因素、给药途径及并发症。分析采用描述性方法。结果:数据库包括51440例病例。其中,分析了3426个案例,其中遭遇的主要原因是有害物质的使用/滥用。女性有害使用/误用药物(N=806, 65.6%)多于非药物(N=423, 34.4%)。男性非药物使用频率(1189,54.1%)高于药物使用频率(1008,45.9%)。女性215例(18.2%),男性137例(6.6%)。女性165例,占14%;男性160例,占7.8%。男性(N=325, 15.8%)和女性(N=67, 5.7%)使用精神活性药物。男性(N=381, 18.5%)和女性(N=151, 12.8%)采用拟交感神经。大多数男性和女性参与者,1712(57.9%),采用口服给药途径。然而,312名(16.5%)男性使用吸入法,而73名(6.8%)女性使用吸入法。结论:毒理学家评估的有害物质使用/滥用患者存在性别差异。考虑到在管理和预防办法方面的这些差异,可能需要指出。
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引用次数: 0
An Updated Version of the Treatment Effectiveness Assessment (TEA) [Letter]. 治疗效果评估(TEA)的更新版本[信]。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2020-02-17 eCollection Date: 2020-01-01 DOI: 10.2147/SAR.S239507
Walter Ling, David Farabee, Vijay R Nadipelli, Brian Perrochet
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引用次数: 3
Erratum: Depot Buprenorphine Injection in the Management of Opioid Use Disorder: From Development to Implementation [Corrigendum]. 勘误:仓库丁丙诺啡注射液在阿片类药物使用障碍管理:从发展到实施[勘误]。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2020-01-31 eCollection Date: 2020-01-01 DOI: 10.2147/SAR.S247083

[This corrects the article DOI: 10.2147/SAR.S155843.].

[这更正了文章DOI: 10.2147/SAR.S155843.]。
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引用次数: 2
Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment. 阿片类药物维持治疗中阿片类药物和多种药物的使用。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2020-01-29 eCollection Date: 2020-01-01 DOI: 10.2147/SAR.S221618
Siv-Elin Leirvaag Carlsen, Linn-Heidi Lunde, Torbjørn Torsheim

Purpose: Opioid maintenance treatment reduces a person's use of heroin. However, frequent substance use in treatment is a problem.

Aim: To examine the association between opioid maintenance treatment and opioid/polydrug use, and whether social factors, adverse experiences, social resources, and quality of life are associated with opioid/polydrug use during the first 12 months in treatment.

Patients and methods: Forty-seven participants from treatment units in Bergen, Norway participated in five waves of data collection. Every third month, a structured face-to-face interview collected self-reported data on sociodemographic characteristics, opioid/polydrug use, participants' social resources or adverse experiences, and quality of life. Data were collected as part of KVARUS, the National Quality Register for Substance Abuse Treatment. A multilevel binary logistic regression analysis was conducted to examine the association of opioid/polydrug use and time in current treatment. The analysis included regressions of opioid/polydrug use on time-invariant baseline adverse experiences and social resources, and time-varying reports of quality of life.

Results: There was a significant negative association between time in treatment and use of opioids, b =-0.89, SE = 0.19, p = <0.01. Furthermore, a negative association of age at substance use on polydrug use was found, b =-0.40, SE =0.19, p = 0.03. A higher overall quality of life was significantly associated with lower odds of opioid use during opioid maintenance treatment, b = -0.62, SE = 0.23, p = < 0.01. Social dimensions, participants' adverse experiences, and social resources were not associated with polydrug or opioid use.

Conclusion: Opioid maintenance treatment is associated with lowered opioid use, but to a lesser degree with polydrug use. Our findings add quality of life as an important factor that should be given particular attention because it can offer insight to aspects that can affect the patients' opioid use.

目的:阿片类药物维持治疗减少一个人对海洛因的使用。然而,在治疗中频繁使用药物是一个问题。目的:探讨阿片类药物维持治疗与阿片类/多种药物使用之间的关系,以及治疗前12个月的社会因素、不良经历、社会资源和生活质量是否与阿片类/多种药物使用有关。患者和方法:来自挪威卑尔根治疗单位的47名参与者参与了五波数据收集。每三个月进行一次结构化的面对面访谈,收集有关社会人口学特征、阿片类药物/多种药物使用、参与者的社会资源或不良经历以及生活质量的自我报告数据。数据是作为KVARUS(国家药物滥用治疗质量登记)的一部分收集的。采用多水平二元logistic回归分析来检验当前治疗中阿片类药物/多种药物使用与时间的关系。分析包括阿片类药物/多种药物使用对时不变基线不良经历和社会资源的回归,以及时变生活质量报告。结果:治疗时间与阿片类药物使用呈显著负相关,b =-0.89, SE =0.19, p = b =-0.40, SE =0.19, p = 0.03。在阿片类药物维持治疗期间,较高的总体生活质量与较低的阿片类药物使用几率显著相关,b = -0.62, SE = 0.23, p = < 0.01。社会维度、参与者的不良经历和社会资源与多种药物或阿片类药物的使用无关。结论:阿片类药物维持治疗与阿片类药物使用减少有关,但与多种药物使用的程度较低。我们的研究结果增加了生活质量作为一个重要因素,应该给予特别关注,因为它可以提供对可能影响患者阿片类药物使用的方面的见解。
{"title":"Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment.","authors":"Siv-Elin Leirvaag Carlsen,&nbsp;Linn-Heidi Lunde,&nbsp;Torbjørn Torsheim","doi":"10.2147/SAR.S221618","DOIUrl":"https://doi.org/10.2147/SAR.S221618","url":null,"abstract":"<p><strong>Purpose: </strong>Opioid maintenance treatment reduces a person's use of heroin. However, frequent substance use in treatment is a problem.</p><p><strong>Aim: </strong>To examine the association between opioid maintenance treatment and opioid/polydrug use, and whether social factors, adverse experiences, social resources, and quality of life are associated with opioid/polydrug use during the first 12 months in treatment.</p><p><strong>Patients and methods: </strong>Forty-seven participants from treatment units in Bergen, Norway participated in five waves of data collection. Every third month, a structured face-to-face interview collected self-reported data on sociodemographic characteristics, opioid/polydrug use, participants' social resources or adverse experiences, and quality of life. Data were collected as part of KVARUS, the National Quality Register for Substance Abuse Treatment. A multilevel binary logistic regression analysis was conducted to examine the association of opioid/polydrug use and time in current treatment. The analysis included regressions of opioid/polydrug use on time-invariant baseline adverse experiences and social resources, and time-varying reports of quality of life.</p><p><strong>Results: </strong>There was a significant negative association between time in treatment and use of opioids, <i>b</i> =-0.89, <i>SE</i> = 0.19, <i>p</i> = <0.01. Furthermore, a negative association of age at substance use on polydrug use was found, <i>b</i> =-0.40, <i>SE</i> =0.19, <i>p</i> = 0.03. A higher overall quality of life was significantly associated with lower odds of opioid use during opioid maintenance treatment, <i>b</i> = -0.62, <i>SE</i> = 0.23, <i>p</i> = < 0.01. Social dimensions, participants' adverse experiences, and social resources were not associated with polydrug or opioid use.</p><p><strong>Conclusion: </strong>Opioid maintenance treatment is associated with lowered opioid use, but to a lesser degree with polydrug use. Our findings add quality of life as an important factor that should be given particular attention because it can offer insight to aspects that can affect the patients' opioid use.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"11 ","pages":"9-18"},"PeriodicalIF":1.8,"publicationDate":"2020-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S221618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37678728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification. 戒毒后海洛因使用者酒精与海洛因使用的反比关系
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2020-01-08 eCollection Date: 2020-01-01 DOI: 10.2147/SAR.S228224
Nirvana Morgan, William Daniels, Ugasvaree Subramaney

Background: Given that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use.

Methods: 300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6-8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints.

Results: Of the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased.

Conclusion: After detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.

背景:鉴于只有不到50%的国家提供阿片类激动剂维持治疗(OAMT),评估在接受戒毒治疗模式的海洛因使用者康复过程中,其他物质是否可以替代海洛因是很重要的。低收入和中等收入国家缺乏评估这些药物使用模式的前瞻性研究。方法:对来自南非豪登省的300名海洛因吸食者进行入院戒毒评估,并在戒毒结束后3个月和9个月进行随访。治疗包括1周的排毒和6-8周的心理治疗。我们在基线和康复后测量了海洛因、酒精和其他药物使用流行率的总体变化。采用广义估计方程(GEE)对入组、3个月和9个月时的结果进行比较,以结果为因变量,观察点为自变量,参与者为重复测量。注射状态和治疗完成作为协变量。我们还测量了210名参与者在所有三个时间点使用海洛因和酒精之间的个体途径。结果:在原始队列中,252人(84.0%)在3个月时重新接受了采访,225人(75.0%)在9个月时重新接受了采访。从基线到3个月,过去一个月的海洛因使用者比例显著下降至65.5%;然而,在此期间,过去一个月的酒精使用者比例从16.3%增加到55.2%(结论:戒毒后,海洛因使用显著减少,同时酒精消费量增加。在这种情况下,酒精可能在短期内成为海洛因的替代品。康复后3个月海洛因使用开始减少,6个月后消费量增加。这一观察结果支持有必要采取干预措施,以预防、监测和治疗戒毒后海洛因使用者的高度酒精使用。提供OAMT是解决酒精摄入量增加的风险以及海洛因戒断率下降的必要考虑因素。
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引用次数: 6
Depot Buprenorphine Injection In The Management Of Opioid Use Disorder: From Development To Implementation 储存库丁丙诺啡注射液治疗阿片类药物使用障碍:从开发到实施
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2019-11-01 DOI: 10.2147/SAR.S155843
W. Ling, S. Shoptaw, D. Goodman-Meza
Abstract Buprenorphine has pharmacologic advantages over methadone, especially buprenorphine’s better safety profile. The true significance of buprenorphine’s introduction lies in returning the care of those suffering from opioid use disorder (OUD) to the hands of the physician. The clinical success of buprenorphine has been meager, in part because most physicians have not been exposed to treating these patients. For physicians inclined to treat OUD, the barriers to buprenorphine’s implementation have been onerous and largely counter to the norms of medical practice. Some notable concerns pertain to buprenorphine’s clinical pharmacology like street diversion, unintended use and accidental poisoning. Recently, injectable buprenorphine preparations have been introduced to mitigate these latter shortcomings. Yet, the injectable preparations’ clinical and commercial success has fallen far short of expectation. Here, we review the clinical pharmacology of these products and their expected clinical advantages for the manufacturers, clinicians, policy makers and patients, and offer our perspective, as clinicians and researchers, on how things can improve. Questions remain whether clinicians are willing to overcome barriers to treat OUD using these medications.
摘要丁丙诺啡在药理学上优于美沙酮,尤其是丁丙诺芬具有更好的安全性。丁丙诺啡引入的真正意义在于将阿片类药物使用障碍(OUD)患者的护理交还给医生。丁丙诺啡的临床成功率很低,部分原因是大多数医生没有接触过治疗这些患者。对于倾向于治疗OUD的医生来说,丁丙诺啡的实施障碍重重,在很大程度上违反了医疗实践规范。一些值得注意的问题与丁丙诺啡的临床药理学有关,如街道改道、意外使用和意外中毒。最近,丁丙诺啡注射液已被引入以减轻后一种缺点。然而,注射制剂的临床和商业成功远远达不到预期。在这里,我们回顾了这些产品的临床药理学及其对制造商、临床医生、政策制定者和患者的预期临床优势,并作为临床医生和研究人员,就如何改进提供了我们的观点。临床医生是否愿意克服使用这些药物治疗OUD的障碍仍然是个问题。
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引用次数: 23
Opioid Use Disorder Treatment Decision Making And Care Navigation Upon Release From Prison: A Feasibility Study. 阿片类药物使用障碍的治疗决策和出狱后的护理导航:可行性研究。
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2019-10-22 eCollection Date: 2019-01-01 DOI: 10.2147/SAR.S192045
Caleb J Banta-Green, Anthony S Floyd, Kristin Vick, Jen Arthur, Theresa J Hoeft, Judith I Tsui

Purpose: Opioid use disorder (OUD) is a medical condition that is effectively treated with medications. A major challenge in breaking the cycle of OUD and related illegal activity is seamlessly introducing medications for opioid use disorder (MOUD) as individuals leave jail or prison. We examined the feasibility of a pilot intervention to link participants to ongoing MOUD and psychosocial supports following release from custody.

Methods: The study enrolled adults with a history of OUD released from Washington State prisons to Department of Corrections (DOC) community supervision. Participants were randomized to the study intervention or comparison group. The intervention consisted of education on OUD and available treatments, support with individualized treatment decision making, and continued care navigation for 6 months to facilitate linkage to chosen treatments. Participants randomized to the control condition received referral to services in the community from their community corrections officers. A care navigation activity log documented intervention participants' intervention engagement, service utilization, and needs. Follow-up interviews were conducted at 1 and 6 months to assess satisfaction with the intervention.

Results: Fifteen participants were enrolled. All were male, most were white (86.6%) and the average age was 36.9 years. The majority (14 of 15 participants) were near-daily heroin users with severe OUD prior to incarceration. Of the seven intervention participants, two wished to start medications immediately. Three participants reported starting buprenorphine or methadone in the subsequent follow-up period, with or without social support and/or outpatient counseling, and three reported enrolling in social support and/or outpatient counseling without medications. Participants who received the intervention reported high satisfaction. We discuss barriers and facilitators to study implementation.

Conclusion: An intervention to link participants to ongoing MOUD and psychosocial supports following release from prison had broad acceptability among participants and was feasible to implement among those recruited; however, enrollment was much lower than anticipated and the study intervention did not demonstrate the intended effect to facilitate use of MOUD immediately post-release in this small sample of participants. Given recent research showing benefits of pre-release medication initiation, the potential added benefits of this two-part intervention should be studied in systems that initiate MOUD prior to release.

目的:阿片类药物使用障碍(OUD)是一种可以通过药物有效治疗的疾病。打破OUD和相关非法活动循环的一个主要挑战是,随着个人离开监狱或监狱,无缝地引入治疗阿片类药物使用障碍(MOUD)的药物。我们研究了试点干预的可行性,以将参与者与在押释放后正在进行的MOOD和心理社会支持联系起来。方法:该研究招募了从华盛顿州监狱释放到惩教部(DOC)社区监督的有OUD病史的成年人。参与者被随机分配到研究干预组或对照组。干预措施包括OUD和可用治疗的教育,支持个性化治疗决策,以及持续6个月的护理导航,以促进与所选治疗的联系。被随机分配到对照组的参与者接受了社区惩教官员的社区服务转介。护理导航活动日志记录了干预参与者的干预参与、服务利用率和需求。在1个月和6个月时进行随访访谈,以评估对干预的满意度。结果:15名参与者被纳入研究。全部为男性,大多数为白人(86.6%),平均年龄36.9岁。大多数(15名参与者中的14名)在监禁前几乎每天都有严重OUD的海洛因使用者。在七名干预参与者中,有两人希望立即开始服药。三名参与者报告称,在随后的随访期内,在有或没有社会支持和/或门诊咨询的情况下,开始服用丁丙诺啡或美沙酮,三名参与者在没有药物的情况下参加了社会支持和(或)门诊咨询。接受干预的参与者表示非常满意。我们讨论了研究实施的障碍和促进因素。结论:将参与者与出狱后正在进行的谅解备忘录和心理社会支持联系起来的干预措施在参与者中具有广泛的可接受性,在被招募者中实施是可行的;然而,入组人数远低于预期,研究干预并未证明在这一小样本参与者中促进释放后立即使用MOUD的预期效果。鉴于最近的研究显示了释放前药物启动的益处,应在释放前启动MOUD的系统中研究这种由两部分组成的干预措施的潜在附加益处。
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引用次数: 5
Information on doctor and pharmacy shopping for opioids adds little to the identification of presumptive opioid abuse disorders in health insurance claims data 关于医生和药房购买阿片类药物的信息对确定健康保险索赔数据中假定的阿片类药物滥用障碍几乎没有帮助
IF 1.8 Q1 SUBSTANCE ABUSE Pub Date : 2019-08-01 DOI: 10.2147/SAR.S201725
A. Walker, L. Weatherby, M. Cepeda, Daniel C Bradford
Background Doctor and pharmacy shopping (“Shopping”) for opioids is related to opioid abuse and is associated with opioid overdose and death. Lacking identifiers for prescribers and pharmacies, many data resources (notably the US FDA’s Sentinel System) cannot evaluate Shopping. We used data in which presumptive Shopping could be identified. We investigated whether US health insurance claims data could perform as well as Shopping to identify people with evidence for opioid abuse. Methods In this cross-sectional study, we examined health insurance claims from 164,923 persons with at least two dispensing of opioids in 18 months, the first occurring in 2012. Evidence for the presence of a possible opioid abuse disorder was drawn from predictive patterns of drug fills, diagnoses and care-seeking identified in a companion research project, and Shopping was determined using a published index. The prevalence of presumptive opioid abuse was examined across levels of Shopping. The comparison between Shopping and insurance-claims-derived covariates in the detection of apparent opioid abuse was examined in multiple regression analyses. Results Despite a strong correlation between presumptive opioid abuse and Shopping, most persons with extensive Shopping did not manifest presumptive opioid abuse, and half of the population with presumptive opioid abuse did not exhibit Shopping. As Shopping ranged from “None” to “Extensive,” the prevalence of presumptive opioid abuse increased from 0.28 to 5.0 per 100. The discriminating power of Shopping for identifying opioid abuse could be replaced using insurance claims data. Conclusion The results suggest that patient characteristics that can be inferred from insurance claims data provide as complete discrimination of persons with presumptive opioid abuse as does a full assessment of doctor and pharmacy shopping. The inference rests on patterns of health services and drug dispensing that are indicative of doctor–pharmacy shopping and of opioid abuse. There was no direct evaluation of patients. The extent to which the conclusions are generalizable beyond the study population – Americans with health insurance coverage in the early part of this decade – is uncertain in a quantitative sense. The qualitative conclusion is that diagnostic data in health insurance databases can be predictive of behaviors consistent with opioid abuse and that more elaborate indices such as doctor and pharmacy shopping may add little. Registration: ClinicalTrials.gov study number: NCT02668549.
医生和药房购买阿片类药物与阿片类药物滥用有关,并与阿片类药物过量和死亡有关。由于缺乏处方者和药店的标识符,许多数据资源(特别是美国FDA的哨兵系统)无法评估购物。我们使用了可以识别推定购物的数据。我们调查了美国健康保险索赔数据是否可以像购物一样识别有阿片类药物滥用证据的人。方法在这项横断面研究中,我们检查了来自164,923名在18个月内至少两次配发阿片类药物的人的健康保险索赔,第一次发生在2012年。可能存在阿片类药物滥用障碍的证据来自一个同伴研究项目中确定的药物填充、诊断和求医的预测模式,购物是使用已发表的指数确定的。推定阿片类药物滥用的流行程度在购物水平上进行了检查。购物和保险索赔衍生的协变量在检测明显的阿片类药物滥用之间的比较在多元回归分析中进行了检验。结果:尽管推定阿片类药物滥用与购物之间存在很强的相关性,但大多数广泛购物的人并未表现出推定阿片类药物滥用,而推定阿片类药物滥用的人口中有一半没有表现出购物。由于购物范围从“无”到“广泛”,推定阿片类药物滥用的患病率从每100人0.28人增加到5.0人。购物识别阿片类药物滥用的辨别能力可以用保险索赔数据取代。结论:从保险索赔数据中推断出的患者特征与对医生和药房购物的全面评估一样,可以完全区分推定的阿片类药物滥用者。这一推论基于表明医生-药房购物和阿片类药物滥用的卫生服务和药物分配模式。没有对患者进行直接评估。这些结论在多大程度上可以推广到研究人群之外——本世纪初拥有医疗保险的美国人——在数量上是不确定的。定性结论是,医疗保险数据库中的诊断数据可以预测与阿片类药物滥用一致的行为,而更详细的指标,如医生和药房购物,可能没有什么帮助。注册:ClinicalTrials.gov研究编号:NCT02668549。
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引用次数: 3
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Substance Abuse and Rehabilitation
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