内华达成瘾专家对xr -纳曲酮治疗OUD的处方模式

IF 0.3 4区医学 Q3 LAW

Journal of Legal Medicine Pub Date : 2021-05-21 DOI:10.1080/01947648.2021.1914481

Samia Mouaki-Benani, A. Sheikh, Joseph P. Hardy, W. Havins

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摘要

内华达成瘾专家Samia Mouaki-Benani研究xr -纳曲酮治疗OUD的处方模式smouaki@student.touro.edu Ansab Sheikh, OMS-II;asheikh5@student.touro.edu Joseph P. Hardy，医学博士，临床教育副院长Weldon Havins，医学博士，法学硕士，FCLM Touro University of Nevada College of Osteopathic Medicine背景:阿片类药物危机是一种全国性的流行病，对美国社区和公共卫生造成了毁灭性的后果。2018年，美国46,802例(70%)药物过量死亡和内华达州372例药物过量死亡与阿片类药物有关。药物辅助治疗(MAT)是一种有效的“全患者”治疗阿片类药物使用障碍(OUD)的方法，将药物与行为治疗和咨询相结合。有三种fda批准的药物用于治疗阿片类药物依赖:纳曲酮、美沙酮和丁丙诺啡。与阿片类激动剂治疗相比，治疗中心很少提供纳曲酮(XR-NTX，或注射缓释形式的维维特罗)。本研究的目的是量化内华达州MAT治疗OUD的处方模式，并了解成瘾专家开或不开MAT的原因。方法:设计了一份调查问卷，并通过邮件发送给内华达州的执业成瘾专家，包括医生(MD和DO)、医师助理和执业护士(以下简称内华达州成瘾专家)。结果:在接受调查的309名内华达州成瘾专家中，34名(11%)做出了回应。内华达州几乎一半(47%)的成瘾专家开了XR-NTX，但只有9%的OUD患者接受了XR-NTX治疗。成瘾专家开出XRNTX的主要原因是注射的频率和药物的非成瘾性。不开XR-NTX的主要原因是其解毒要求(35%的受访者)、可及性(29%)和价格(24%)。在没有开XR-NTX处方的内华达州成瘾专家中，28%的人不熟悉这种药物。结论:调查结果表明，正如CDC和其他研究表明的那样，XR-NTX仅适用于一小部分OUD患者。XR-NTX在高度积极的患者中具有潜力，2021年美国法律医学学院法律医学杂志2021年，第41卷，NO。S1, 27-28 https://doi.org/10.1080/01947648.2021.1914481在戒毒期间愿意放弃阿片类药物使用的人，愿意支付较高费用的人，以及刑事司法系统中的患者。可能需要在医疗培训中尽早提高对MAT选择的认识和教育，以弥补与OUD患者可用治疗方法相关的知识差距。本研究的普遍性受到调查对象较少的限制。参考文献可根据要求提供

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Prescribing Patterns of XR-Naltrexone for Treating OUD by Nevada Addiction Specialists

Prescribing Patterns of XR-Naltrexone for Treating OUD by Nevada Addiction Specialists Samia Mouaki-Benani, OMS-II; smouaki@student.touro.edu Ansab Sheikh, OMS-II; asheikh5@student.touro.edu Joseph P. Hardy, MD, Associate Dean for Clinical Education Weldon Havins, MD, JD, LLM, FCLM Touro University Nevada College of Osteopathic Medicine Background: The Opioid crisis is a nationwide epidemic with devastating consequences to American communities and public health. In 2018, 46,802 (70%) of all overdose deaths in the United States, and 372 drug overdose deaths in Nevada, were opioid-related. Medication-assisted treatment (MAT) is an effective “whole-patient” approach to the treatment of opioid use disorder (OUD), combining medications with behavioral therapy and counseling. There are three FDAapproved medications indicated for opioid dependency: naltrexone, methadone, and buprenorphine. Treatment centers rarely offer naltrexone (XR-NTX, or Vivitrol available in injectable extended release form) compared with opioid agonist treatments. The goal of this study is to quantify prescribing patterns of MAT to treat OUD in Nevada and to understand the reasons addiction specialists do or do not prescribe it. Methods: A survey was created with questions designed and sent to practicing Nevada addiction specialists, including physicians (MD and DO), physician assistants, and nurse practitioners in the state of Nevada (Nevada Addiction Specialists hereafter), by mail. Results: Of 309 Nevada Addiction Specialists surveyed, 34 (11%) responded. Almost half (47%) of responding addiction specialists in Nevada prescribed XR-NTX, yet only 9% of OUD patients were treated with XR-NTX. The leading reasons addiction specialists prescribed XRNTX were the frequency of injections and the non-addictive nature of the drug. The leading reasons for not prescribing XR-NTX were its detoxification requirement (35% of respondents), accessibility (29%), and price (24%). Of the Nevada addiction specialists who did not prescribe XR-NTX, 28% were unfamiliar with the drug. Conclusion: The survey results suggest that XR-NTX is appropriate for only a small subset of patients with OUD, as indicated by the CDC and other studies. XR-NTX has potential in highly motivated patients that are 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 27–28 https://doi.org/10.1080/01947648.2021.1914481 willing to abstain from opioid use during the detox period, those willing to pay the higher cost, and patients in the criminal justice system. There may be a need for increasing awareness and education of MAT options earlier in medical training to bridge the gap in knowledge related to the treatments available for patients with OUD. The generalizability of this study is limited by the small number of respondents. References available upon request 28 ABSTRACT

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来源期刊

Journal of Legal Medicine Multiple-

CiteScore

1.10

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0.00%

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期刊介绍： The Journal of Legal Medicine is the official quarterly publication of the American College of Legal Medicine (ACLM). Incorporated in 1960, the ACLM has among its objectives the fostering and encouragement of research and study in the field of legal medicine. The Journal of Legal Medicine is internationally circulated and includes articles and commentaries on topics of interest in legal medicine, health law and policy, professional liability, hospital law, food and drug law, medical legal research and education, the history of legal medicine, and a broad range of other related topics. Book review essays, featuring leading contributions to the field, are included in each issue.