Uptake of Low-dose Buprenorphine Initiation and Associated Patient Characteristics in British Columbia, Canada: A Population-based Cohort Study.

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE

Journal of Addiction Medicine Pub Date : 2025-03-27 DOI:10.1097/ADM.0000000000001483

Nikki Bozinoff, Jingxin Lei, Tamara Mihic, Jessica Moe, Heather Palis, Seonaid Nolan, Lianping Ti, Mary Clare Kennedy

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引用次数: 0

Abstract

Objectives: To characterize patterns of outpatient buprenorphine induction and examine factors associated with the use of low-dose initiation (LDI).

Methods: A retrospective cohort study of 4510 adults initiating buprenorphine between January 1, 2016 and December 31, 2019 in British Columbia (BC), Canada, was undertaken using linked administrative data in the Provincial Overdose Cohort, which contains a 20% random sample of BC residents. Using multivariable modelling, we examined the association between sociodemographic, co-morbidity, treatment, and health service utilization variables, and the outcome of LDI. Joinpoint analysis was also conducted to assess inflection points in the prevalence of this practice.

Results: Overall, 7.2% of included buprenorphine inductions during the study period were classified as LDI. Joinpoint analysis revealed that the percentage of buprenorphine inductions classified as LDI increased significantly beginning in the fourth quarter of 2017. In multivariable analyses, factors positively associated with LDI included: older age (adjusted odds ratio [aOR]: 1.01, 95% CI: 1.00-1.02), living in Vancouver Coastal (aOR: 1.53, 95% CI: 1.13-2.06) and Fraser Health Authority regions (aOR: 2.56, 95% CI: 1.89-3.48) (vs interior region); having been prescribed slow-release oral morphine for opioid use disorder in the last 3 years (aOR: 4.03, 95% CI: 2.51-6.49), and having 1 (aOR: 2.40, 95% CI: 1.80-3.20) or ≥2 (vs 0) opioid agonist treatment episodes in the last 5 years (aOR: 2.56, 95% CI: 1.89-3.48). Factors negatively associated with microinduction included: male sex (aOR: 0.50, 95% CI:0.41-0.61), alcohol use disorder (aOR: 0.62, 95% CI: 0.40-0.96), injection drug use (aOR: 0.75, 95% CI: 0.61-0.94) and past-year incarceration (aOR: 0.19, 95% CI: 0.10-0.33).

Conclusions: The use of LDI has increased in BC in recent years. Markers of treatment experience were positively associated with receipt of LDI. A ssessment of outcomes associated with LDI is needed.

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加拿大不列颠哥伦比亚省低剂量丁丙诺啡起始和相关患者特征的摄取：一项基于人群的队列研究。

目的：表征门诊丁丙诺啡诱导模式，并检查与使用低剂量起始（LDI）相关的因素。方法：对2016年1月1日至2019年12月31日期间在加拿大不列颠哥伦比亚省（BC）开始使用丁丙诺啡的4510名成年人进行回顾性队列研究，使用省级过量队列的相关管理数据，其中包含20%的BC省居民随机样本。使用多变量模型，我们检验了社会人口学、合并症、治疗和卫生服务利用变量与LDI结果之间的关系。还进行了联合点分析，以评估这种做法流行的拐点。结果：总体而言，7.2%的丁丙诺啡诱导在研究期间被归类为LDI。Joinpoint分析显示，从2017年第四季度开始，归类为LDI的丁丙诺啡诱导的百分比显着增加。在多变量分析中，与LDI呈正相关的因素包括：年龄较大（调整优势比[aOR]: 1.01, 95% CI: 1.00-1.02），居住在温哥华沿海地区（aOR: 1.53, 95% CI: 1.13-2.06）和弗雷泽卫生管理局地区（aOR: 2.56, 95% CI: 1.89-3.48）（与内陆地区相比）；在过去的3年里服用过缓释口服吗啡治疗阿片类药物使用障碍（aOR: 4.03, 95% CI: 2.51-6.49），并且在过去的5年里服用过1次（aOR: 2.40, 95% CI: 1.80-3.20）或≥2次（aOR: 2.56, 95% CI: 1.89-3.48）阿片类药物激动剂治疗。与微量诱导负相关的因素包括：男性（aOR: 0.50, 95% CI:0.41-0.61）、酒精使用障碍（aOR: 0.62, 95% CI: 0.40-0.96）、注射药物使用（aOR: 0.75, 95% CI: 0.61-0.94）和过去一年的监禁（aOR: 0.19, 95% CI: 0.10-0.33）。结论：近年来，不列颠哥伦比亚省LDI的使用有所增加。治疗经验的标记与LDI的接受呈正相关。需要对与LDI相关的结果进行评估。

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

Journal of Addiction Medicine 医学-药物滥用

CiteScore

6.10

自引率

9.10%

发文量

260

审稿时长

>12 weeks

期刊介绍： The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.