Patterns of publicly funded naltrexone use among patients diagnosed with alcohol use disorder in Ontario.

IF 2.1 4区 医学 Q3 SUBSTANCE ABUSE
Nima Tourchian, Daniel McCormack, Pamela Leece, Mina Tadrous, Tara Gomes
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Abstract

Aims: Naltrexone is recommended first-line to manage alcohol use disorder (AUD). With previous studies indicating poor retention on naltrexone, we determined duration of naltrexone use and assessed the association between prescription setting and time to discontinuation in Ontario.

Methods: We conducted a retrospective population-based cohort study among Ontario public drug beneficiaries diagnosed with AUD who initiated publicly funded naltrexone from June 2018 to September 2019. The primary outcome was time to naltrexone discontinuation, with a secondary analysis assessing receipt of at least one prescription refill. We used Cox proportional hazards models and logistic regression to test the association between prescription setting and each medication persistence outcome.

Results: Among 2531 new naltrexone patients with AUD, the median duration of naltrexone use was 31 days and 394 (15.6%) continued naltrexone for 6 months or longer. There was no association between setting of initiation and duration of naltrexone use; however, those initiating naltrexone following an acute inpatient hospital stay were more likely to fill a second prescription (aOR 1.43, 95% CI 0.96-2.14), while those initiating after an ED visit were less likely to be dispensed a second prescription (aOR = 0.69, 95% CI 0.52-0.90) compared to those starting in a physician's office.

Conclusion: Persistence on naltrexone to treat an AUD is low, regardless of the setting of initiation. Further research is needed to elucidate the barriers encountered by patients with AUD that lead to poor treatment persistence in order to develop interventions that facilitate patient-centered access to evidence-based treatment for AUD in the province.

安大略省被诊断为酒精使用障碍的患者使用公共资助的纳曲酮的模式。
目的:纳曲酮被推荐为控制酒精使用障碍(AUD)的一线药物。由于之前的研究表明纳曲酮的保留率较低,我们确定了纳曲酮的使用时间,并评估了安大略省处方设置与停药时间之间的关联:我们对2018年6月至2019年9月期间开始使用公共资助的纳曲酮的安大略省公共药物受益人进行了一项基于人群的回顾性队列研究。主要结果是停用纳曲酮的时间,次要分析是评估是否收到至少一次处方续订。我们使用 Cox 比例危险模型和逻辑回归来检验处方设置与每种用药持续性结果之间的关联:在 2531 名新的纳曲酮 AUD 患者中,使用纳曲酮的中位时间为 31 天,394 人(15.6%)持续使用纳曲酮 6 个月或更长时间。开始使用纳曲酮的环境与持续时间之间没有关联;但是,与在医生办公室开始使用纳曲酮的患者相比,在急性住院病人住院后开始使用纳曲酮的患者更有可能获得第二张处方(aOR 1.43,95% CI 0.96-2.14),而在急诊室就诊后开始使用纳曲酮的患者获得第二张处方的可能性较小(aOR = 0.69,95% CI 0.52-0.90):结论:无论在何种情况下开始使用纳曲酮治疗 AUD,持续用药率都很低。需要开展进一步研究,以阐明导致AUD患者治疗持续性差的障碍,从而制定干预措施,促进该省AUD患者获得以患者为中心的循证治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Alcohol and alcoholism
Alcohol and alcoholism 医学-药物滥用
CiteScore
4.70
自引率
3.60%
发文量
62
审稿时长
4-8 weeks
期刊介绍: About the Journal Alcohol and Alcoholism publishes papers on the biomedical, psychological, and sociological aspects of alcoholism and alcohol research, provided that they make a new and significant contribution to knowledge in the field. Papers include new results obtained experimentally, descriptions of new experimental (including clinical) methods of importance to the field of alcohol research and treatment, or new interpretations of existing results. Theoretical contributions are considered equally with papers dealing with experimental work provided that such theoretical contributions are not of a largely speculative or philosophical nature.
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