緊急診療 ブプレノルフィンの開始,その後の処方,および継続的な処方
Annette M Dekker1, David L Schriger1,2, Andrew A Herring3,4
1Department of Emergency Medicine, David Geffen School of Medicine, University of California, Los Angeles.
JAMA
|February 19, 2025
まとめ
カリフォルニアの緊急診療では,2017年から2022年にかけて,オピオイド使用障害 (OUD) に対してブプレノルフィンを処方することが増加している. EDでブプレノルフィンを投与した9人のうち約1人は1年以内に継続的な処方箋を受けていました.
科学分野:
- 緊急 医療
- 依存症 医学
- 公衆衛生
背景:
- オピオイド使用障害 (OUD) と関連する死亡率は,米国では依然として重大な公衆衛生上の問題である.
- ブプレノルフィンの治療は,OUDに関連する罹病率と死亡率を効果的に減少させます.
- 全国的なイニシアチブは,ブプレノルフィンの導入を緊急治療室 (ED) で拡大し,恵まれない人口に達することを目指しています.
研究 の 目的:
- カリフォルニアのOUDの緊急診療医によるブプレノルフィンの開始の傾向を分析する.
- EDが誘発したブプレノルフィンの後の処方パターンと治療継続性を調べる.
- 緊急診療でブプレノルフィンを処方する時の変化を評価する
主な方法:
- カリフォルニア州規制物質利用レビュー・評価システム (CURES) データベースを利用した遡及的観察研究.
- 2017年1月1日から2022年12月31日までのブプレノルフィンの処方箋の分析
- カリフォルニア州の郵便番号を持つ18歳から79歳の患者が,ブプレノルフィンの処方箋を記入した.
主要な成果:
- ブプレノルフィンを処方する緊急医療従事者の割合は2017年の2%から2022年の16%に増加した.
- 研究期間中,緊急診療の医師によるブプレノルフィンの処方量は0. 1%から5%に増加しました.
- 治療開始から40日以内に2回目の処方箋を受けた患者の継続率は2. 8であり,1年以内に継続処方箋を受けた患者は9. 1でした.
結論:
- カリフォルニアの緊急診療医は2017年から2022年の間にOUDに対するブプレノルフィンの処方量を大幅に増加させた.
- EDでブプレノルフィンを開始した患者の有意な割合は,その後継続的な治療を受けた.
- OUDの治療へのアクセスを拡大する際に緊急治療室の役割が 支持されています
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