社区康复干预对阿片类药物使用障碍（mod）的开始、保留和联系的影响：一项随机等待名单对照试验

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-07-09 DOI:10.1016/j.drugalcdep.2025.112785

Jennifer L. Brown , Marc R. Larochelle , Laura C. Fanucchi , Deirdre C. Calvert , Aimee N.C. Campbell , Redonna K. Chandler , Daniel J. Feaster , LaShawn M. Glasgow , Erin B. Gibson , JaNae Holloway , Michelle R. Lofwall , Aimee Mack , Nicole Mack , Edward V. Nunes , Jeffery C. Talbert , Sylvia Tan , Nathan Vandergrift , Jennifer Villani , Kat Asman , Hermik Babakhanlou-Chase , Sharon L. Walsh

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引用次数: 0

摘要

阿片类药物使用障碍（mod）药物可以减少阿片类药物的使用和过量死亡。本研究考察了社区康复（CTH）干预是否增加了mod的启动、保留和联系。康复社区研究是一项多地点、双组、平行、社区水平、集群随机、非盲、等待名单对照试验，在67个社区进行（n = 34个干预组，n = 33个对照组）。使用处方药监测项目和医疗补助索赔数据，我们比较了1年比较期内（2021年7月至2022年6月）mod结果的平均社区水平率：(a)至少一次mod收据；(b)持续180天的发票收据；(c)在与阿片类药物有关的急诊部门或医院遭遇后31天内与mod联系。对于干预社区和对照社区，每1000名医疗补助登记者中至少接受一次mod的调整率分别为578人（95% CI: 562,594）和596人（95% CI: 572,621）[调整相对率(aRR)= 0.97 (95% CI: 0.93, 1.01)]。在干预社区和对照社区，每1000名至少接受一次mod治疗的医疗补助计划参保者中，连续180天（保留）接受mod治疗的调整率分别为614 （95% CI: 595, 634）和620 (95% CI: 603, 638) [aRR= 0.99 (95% CI: 0.95, 1.04)]。干预社区和对照社区的校正连锁率分别为每1000次接触280例（95% CI: 254, 310）和252例（95% CI: 226, 281） [aRR= 1.11 (95% CI: 0.96, 1.28)]。与对照组相比，接受CTH干预的社区并没有显示出更高的mod使用率、保留率或联系率。需要进一步努力，以提高对mod的吸收和持续使用。临床试验注册号：NCT04111939

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Effects of the Communities That HEAL intervention on initiation, retention, and linkage to medications for opioid use disorder (MOUD): A cluster randomized wait-list controlled trial

Medications for opioid use disorder (MOUD) can reduce opioid use and overdose deaths. This study examined whether the Communities That HEAL (CTH) intervention increased MOUD initiation, retention, and linkage. The HEALing Communities Study was a multi-site, 2-arm, parallel, community-level, cluster-randomized, unblinded, wait-list controlled trial conducted in 67 communities (n = 34 intervention, n = 33 control). Using Prescription Drug Monitoring Programs and Medicaid claims data, we compared mean community-level rates of MOUD outcomes during the 1-year comparison period (July 2021-June 2022) for: (a) MOUD receipt at least once; (b) continuous MOUD receipt for 180 days; and (c) MOUD linkage within 31 days following an opioid-related emergency department or hospital encounter. For intervention and control communities, adjusted rates of receiving MOUD at least once were 578 (95 % CI: 562, 594) and 596 (95 % CI: 572, 621) per 1000 Medicaid enrollees, respectively [adjusted Relative Rate (aRR)= 0.97 (95 % CI: 0.93, 1.01)]. Adjusted rates of receiving MOUD for 180 consecutive days (retention) were 614 (95 % CI: 595, 634) and 620 (95 % CI: 603, 638) per 1000 Medicaid enrollees receiving MOUD at least once for intervention and control communities, respectively [aRR= 0.99 (95 % CI: 0.95, 1.04)]. The adjusted rate of linkage was 280 (95 % CI: 254, 310) and 252 (95 % CI: 226, 281) per 1000 encounters for intervention and control communities, respectively [aRR= 1.11 (95 % CI: 0.96, 1.28). Compared to control communities, communities that received the CTH intervention did not demonstrate higher rates of MOUD use, retention, or linkage. Additional efforts are needed to improve uptake and sustained use of MOUD.

Trial registration

ClinicalTrials.gov Identifier: NCT04111939

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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.