有阿片类药物使用障碍的无家可归成人前瞻性队列中的丁丙诺啡依从性

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-02-15 DOI:10.1016/j.drugalcdep.2025.112598

Danielle R. Fine , Natalia Critchley , Katherine Hart , Susan Regan , Nora Sporn , Jessie Gaeta , Joe Wright , Gina Kruse , Travis P. Baggett

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引用次数: 0

摘要

无家可归者面临着与阿片类药物相关的高死亡率。丁丙诺啡是一种降低阿片类药物相关死亡率的药物，但无家可归者对这种药物的依从性并没有充分的记录。本研究评估了丁丙诺啡在高危人群中的依从性，并确定了与之相关的因素。方法：我们在2022年6月1日至2023年5月1日期间，对参加波士顿无家可归者医疗保健项目门诊阿片类药物治疗（OBOT）项目的英语和西班牙语成年人（≥18岁）进行了一项前瞻性队列研究。我们的主要终点是丁丙诺啡的依从性，用覆盖天数百分比（PDC）来衡量。我们使用多变量线性回归来确定与丁丙诺啡依从性独立相关的人口统计学、社会决定因素和临床特征。结果139名参与者中，23%为女性，45%为非西班牙裔白人，37%为西班牙裔，13%为非西班牙裔黑人，平均年龄为42岁。在4个月的随访期间，平均PDC为49.4%。老年(β = 7.03% / 10年；95% CI= 1.99% - 12.08%)，基线时居住在住宅治疗设施中(与无家可归者相比；β= 14.6%;95% CI= 1.7% - 27.6%)，基线恢复水平更高(恢复评分每增加1分β = 0.77%；95% CI= 0.21% - 1.32%)，丁丙诺啡最大剂量较高(16 mg vs.≤16 mg；β= 13.1%;95% CI= 2.4% - 23.9%)，接受丁丙诺啡缓释(β = 18.1%；95% CI= 4.3% - 31.9%)与较大的PDC独立相关。结论：在这个无家可归的成年人队列中，丁丙诺啡的依从性在4个月内约为50%。主动增加丁丙诺啡剂量，考虑缓释制剂，并确保在住宅治疗环境中获得丁丙诺啡，可能会改善这一边缘化人群的依从性。

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Buprenorphine adherence among a prospective cohort of homeless-experienced adults with opioid use disorder

Introduction

People experiencing homelessness face high rates of opioid-related mortality. Buprenorphine is a medication that reduces opioid-related mortality, but adherence to this medication among people experiencing homelessness is not well-documented. This study assessed buprenorphine adherence and identified factors associated with it in this high-risk population.

Methods

We conducted a prospective cohort study of English- and Spanish-speaking adults (

\geq

18 years) enrolled in the Boston Health Care for the Homeless Program outpatient-based opioid treatment (OBOT) program from 1/6/2022–1/5/2023. Our primary outcome was buprenorphine adherence, measured by the percentage of days covered (PDC). We used multivariable linear regression to identify demographics, social determinants, and clinical characteristics independently associated with buprenorphine adherence.

Results

Of 139 participants, 23 % were female, 45 % were non-Hispanic White, 37 % were Hispanic, 13 % were non-Hispanic Black, and the mean age was 42 years. The mean PDC was 49.4 % over the 4-month follow-up period. Older age (beta=7.03 % per decade; 95 % CI=1.99 %-12.08 %), living in a residential treatment facility at baseline (vs. being unhoused; beta=14.6 %; 95 % CI=1.7 %-27.6 %), higher levels of baseline recovery (beta=0.77 % per one-point increase in the recovery score; 95 % CI=0.21 %-1.32 %), a higher maximum buprenorphine dose (>16 mg vs.

\leq

16 mg; beta=13.1 %; 95 % CI=2.4 %-23.9 %), and receiving extended-release buprenorphine (beta=18.1 %; 95 % CI=4.3 %-31.9 %) were independently associated with a greater PDC.

Conclusions

Buprenorphine adherence in this cohort of homeless-experienced adults was approximately 50 % over 4 months. Proactive up-titration of buprenorphine dosing, consideration of extended-release formulation, and ensured access to buprenorphine in residential treatment settings may improve adherence in this marginalized population.

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.