美国加州大学洛杉矶分校Elizabeth A. Samuels课题组近日分析了急诊临床医生丁丙诺啡的起始、后续处方和连续处方。相关论文于2025年2月19日发表在《美国医学会杂志》上。

美国阿片类药物使用障碍（OUD）的发病率和相关死亡率仍然很高。丁丙诺啡治疗OUD可降低发病率和死亡率。全美国都在努力将丁丙诺啡的使用范围扩大到急诊科（ED），许多治疗机会低的患者在急诊科寻求医疗护理。急诊临床医生丁丙诺啡处方的采用和趋势尚不清楚。

为了描述加利福尼亚州急诊临床医生丁丙诺啡开始治疗OUD、随后的处方和随时间的变化。2017年1月1日至2022年12月31日，研究组对加州受控物质利用审查和评估系统（CURES）数据库中丁丙诺啡处方进行了一项观察性回顾性研究。任何年龄在18至79岁之间、加州邮政编码为CURES的丁丙诺啡处方患者及其加州处方医生都有资格被纳入。暴露因素为急诊临床医生开具的丁丙诺啡处方。主要结果包括：（1）服用丁丙诺啡的患者人数；（2） 开具丁丙诺啡处方的临床医生数量；（3） 丁丙诺啡处方的数量和特点；（4） 急诊临床医生丁丙诺啡起始处方与随后第二处方和连续处方相关的百分比，也报告为持续比率；以及（5）连续处方前的起始处方天数和数量。

在这项回顾性观察研究中，2017年至2022年，345024名患者从加利福尼亚州的21099名临床医生那里获得了380万张丁丙诺啡处方。首次开具丁丙诺啡处方时患者的平均年龄为37岁；8187名（67%）为男性。2017年和2022年，丁丙诺啡处方医生的急诊临床医生分别从2%（n=78）增加到16%（n=1789）（P < .001）。2017年和2022年，急诊临床医生开具的丁丙诺啡起始处方分别从所有起始处方的0.1%（n=53）增加到5%（n=4493）（P=0.001）。患者在ED起始后40天内接受第二次处方的持续比率为2.8（10823/3916）。患者在开始服用丁丙诺啡后40天内开始服用180天或更长时间的连续处方的持续率为18.3（10823/593），在1年内为9.1（5989/655[2017-2021年数据]）。

这些发现表明，从2017年到2022年，加利福尼亚州急诊临床医生增加了丁丙诺啡治疗OUD的处方，大约九分之一的患者在一年内继续接受丁丙诺吗啡的连续处方。

附：英文原文

Title: Emergency Clinician Buprenorphine Initiation, Subsequent Prescriptions, and Continuous Prescriptions

Author: Annette M. Dekker, David L. Schriger, Andrew A. Herring, Elizabeth A. Samuels

Issue&Volume: 2025-02-19

Abstract:

Importance  Rates of opioid use disorder (OUD) and associated mortality in the US remain high. Treatment of OUD with buprenorphine reduces morbidity and mortality. There have been national efforts to expand buprenorphine initiation to the emergency department (ED), where many patients with low treatment access seek medical care. Adoption and trends of emergency clinician buprenorphine prescribing are unknown.

Objective  To describe emergency clinician buprenorphine initiation for OUD, subsequent prescriptions, and changes over time in California.

Design, Setting, and Participants  Observational retrospective study of buprenorphine prescriptions in the California Controlled Substance Utilization Review and Evaluation System (CURES) database from January 1, 2017, to December 31, 2022. Any patient aged 18 to 79 years with a California zip code who filled a buprenorphine prescription in CURES and their California prescribers were eligible for inclusion.

Exposure  Buprenorphine prescription by an emergency clinician.

Main Outcomes and Measures  Outcomes included (1) the number of patients prescribed buprenorphine; (2) the number of clinicians prescribing buprenorphine; (3) the number and characteristics of buprenorphine prescriptions; (4) the percentage of emergency clinician buprenorphine initiation prescriptions with subsequent linkage to a second prescription and continuous prescriptions, also reported as a continuation ratio; and (5) days and number of initiation prescriptions prior to continuous prescriptions.

Results  In this retrospective observational study, 345024 patients received 3.8 million buprenorphine prescriptions from 21099 clinicians in California from 2017 to 2022. The mean age of patients at the time of first buprenorphine prescription was 37 years; 8187 (67%) were male. Emergency clinicians increased from 2% (n=78) to 16% (n=1789) of buprenorphine prescribers in 2017 and 2022, respectively (P<.001). Buprenorphine initiation prescriptions by emergency clinicians increased from 0.1% (n=53) to 5% (n=4493) of all initiation prescriptions in 2017 and 2022, respectively (P=.001). The continuation ratio for patients to receive a second prescription within 40 days of an ED initiation was 2.8 (10823/3916). The continuation ratio for patients to start 180 days or more of continuous prescriptions within 40 days of ED buprenorphine initiation was 18.3 (10823/593) and 9.1 within 1 year (5989/655 [2017-2021 data]).

Conclusions and Relevance  These findings suggest increasing prescription of buprenorphine for OUD by California emergency clinicians from 2017 to 2022, with approximately 1 in 9 patients going on to receive continuous buprenorphine prescriptions within 1 year.

DOI: 10.1001/jama.2024.27976

Source: https://jamanetwork.com/journals/jama/fullarticle/2830615