84. Tổng quan luận điểm về duy trì trong điều trị nghiện chất dạng thuốc phiện bằng thuốc Buprenorphine tác dụng kéo dài dạng tiêm
Nội dung chính của bài viết
Tóm tắt
Duy trì điều trị là yếu tố then chốt để tối ưu hiệu quả điều trị trong điều trị nghiện chất dạng thuốc phiện (CDTP). Thuốc buprenorphine (BUP) tác dụng kéo dài dạng tiêm là một loại thuốc mới với ưu thế trong việc cải thiện duy trì điều trị. Nghiên cứu tổng quan luận điểm này được thực hiện nhằm tổng hợp các bằng chứng hiện có về đặc điểm duy trì trong điều trị bằng BUP tác dụng kéo dài dạng tiêm và các yếu tố ảnh hưởng đến duy trì điều trị. Qua tìm kiếm và phân tích 22 nghiên cứu trên nhiều bối cảnh và đối tượng, tỷ lệ duy trì điều trị sau 6 tháng dao động từ 65,5% - 86% trong các thử nghiệm lâm sàng và 42,9 - 80,8% trong các nghiên cứu quan sát. Điều trị nghiện CDTP bằng thuốc BUP tiêm tác dụng kéo dài khả thi trong nhiều bối cảnh khác nhau. Tuy nhiên, tỷ lệ duy trì điều trị chịu ảnh hưởng bởi nhiều yếu tố, bao gồm: đặc điểm người bệnh, phương thức triển khai chương trình cũng như chính sách chi trả của bảo hiểm y tế. Lựa chọn nhóm đối tượng phù hợp, cung cấp đầy đủ thông tin, tư vấn và hỗ trợ người bệnh toàn diện trước và trong quá trình điều trị, áp dụng mô hình kê đơn và chính sách chi trả bảo hiểm y tế phù hợp có thể giúp nâng cao tỷ lệ duy trì và hiệu quả lâm sàng của BUP tác dụng kéo dài dạng tiêm.
Chi tiết bài viết
Từ khóa
Chất dạng thuốc phiện, buprenorphine, tác dụng kéo dài, dạng tiêm, duy trì điều trị
Tài liệu tham khảo
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26. Farrell M, Shahbazi J, Byrne M, et al. Outcomes of a single-arm implementation trial of extended-release subcutaneous buprenorphine depot injections in people with opioid dependence. Int J Drug Policy. 2022; 100: 103492. doi:10.1016/j.drugpo.2021.103492.
27. Macdonald T, Connor P, Edwards J, Hardy M, Kemp D, Johnston L. Real-world retention rates with a long-acting buprenorphine depot in opioid-dependent patients attending private clinics in Australia. Heroin Addict Relat Clin Probl. 2022; 24(2): 19-25
28. Nunes EV, Comer SD, Lofwall MR, et al. Extended-release injection vs sublingual buprenorphine for opioid use disorder with fentanyl use: A post hoc analysis of a randomized clinical trial. JAMA Netw Open. 2024; 7(6): e2417377. doi:10.1001/jamanetworkopen.2024.17377.
29. Farrell M, Shahbazi J, Chambers M, et al. 96-week retention in treatment with extended-release subcutaneous buprenorphine depot injections among people with opioid dependence: Extended follow-up after a single-arm trial. Int J Drug Policy. 2024; 127: 104390. doi:10.1016/j.drugpo.2024.104390.
30. Cheng A, Badolato R, Segoshi A, et al. Perceptions and experiences toward extended-release buprenorphine among persons leaving jail with opioid use disorders before and during COVID-19: an in-depth qualitative study. Addict Sci Clin Pract. 2022; 17(1): 4. doi:10.1186/s13722-022-00288-4.
31. Clay S, Treloar C, Degenhardt L, et al. “I just thought that was the best thing for me to do at this point”: Exploring patient experiences with depot buprenorphine and their motivations to discontinue. Int J Drug Policy. 2023; 115: 104002. doi:10.1016/j.drugpo.2023.104002.
32. Mariani JJ, Mahony A, Iqbal MN, Luo SX, Naqvi NH, Levin FR. Case series: Rapid induction onto long acting buprenorphine injection for high potency synthetic opioid users. Am J Addict. 2020; 29(4): 345-348. doi:10.1111/ajad.13018.
33. Mariani JJ, Mahony AL, Podell SC, et al. Open-label trial of a single-day induction onto buprenorphine extended-release injection for users of heroin and fentanyl. Am J Addict. 2021; 30(5): 470-476. doi:10.1111/ajad.13193.
34. Andrada E, Rodriguez M, Bandalan JH, Dangelo-Kemp D, Johnston L, Wilson H. Retention rates with monthly depot buprenorphine in general practice in Melbourne, Australia. Aust J Gen Pract. 2022; 51(6): 447-451. doi:10.31128/AJGP-07-21-6098.
35. Cotton AJ, Lo K, Kurtz FB, Waldbauer L. Extended-release buprenorphine outcomes among treatment resistant veterans. Am J Drug Alcohol Abuse. 2022; 48(3): 334-337. doi:10.1080/00952990.2021.1992773.
36. Stein MD, VanNoppen D, Herman DS, Anderson BJ, Conti M, Bailey GL. Retention in care for persons with opioid use disorder transitioning from sublingual to injectable buprenorphine. J Subst Abuse Treat. 2022; 136: 108661. doi:10.1016/j.jsat.2021.108661.
37. Galati BM, Wenzinger M, Rogers CE, Cooke E, Kelly JC. Buprenorphine extended-release treatment for opioid use disorder in the postpartum period. Obstet Gynecol. 2023; 142(5): 1148-1152. doi:10.1097/AOG.0000000000005319.
38. Iacono A, Wang T, Tadrous M, et al. Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: A population-based cohort study in Ontario, Canada. Drug Alcohol Depend. 2024; 254: 111032. doi:10.1016/j.drugalcdep.2023.111032.
39. Hammerslag LR, Talbert J, Slavova S, et al. Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder in Kentucky, before and after COVID-19 related buprenorphine access policy changes. J Subst Use Addict Treat. 2024; 164: 209391. doi:10.1016/j.josat.2024.209391.
40. Heil J, Salzman M, Hunter K, et al. Evaluation of an injectable monthly extended-release buprenorphine program in a low-barrier specialty addiction medicine clinic. J Subst Use Addict Treat. 2024; 156: 209183. doi:10.1016/j.josat.2023.209183.
41. Mlilo K, Fatema K, Poudel P, Harjanto R, Whitton G. Comparing the effectiveness of depot buprenorphine (buvidal injection) and buprenorphine/naloxone (suboxone) treatment following custody release - a retrospective cohort study. J Subst Use. 2024; 29(3): 257-265. doi:10.1080/14659891.2024.2342313.
42. Perdue M, Hosseini Ghomi R, Rees P, Arzubi E. 5-Day injectable extended-release buprenorphine initiation in non-opioid-tolerant individuals in a carceral setting: A case series. J Addict Med. 2024; 18(4): 335-339. doi:10.1097/ADM.0000000000001387.
43. Neptune A, Kaliamurthy S. The use of extended-release buprenorphine in the treatment of adolescent opioid use disorder: A case series. J Addict Med. 2025; 19(2): 150-154. doi:10.1097/ADM.0000000000001447.
44. O’Connor AM, Cousins G, Durand L, Barry J, Boland F. Retention of patients in opioid substitution treatment: A systematic review. PLoS One. 2020; 15(5): e0232086. doi:10.1371/journal.pone.0232086.
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2. World Health Organization. Opioid overdose. Published August 29, 2023. Accessed November 28, 2024. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose.
3. National Institute on Drug Abuse. Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021. Published August 7, 2023. Accessed April 24, 2024. https://nida.nih.gov/news-events/news-releases/2023/08/only-1-in-5-us-adults-with-opioid-use-disorder-received-medications-to-treat-it-in-2021.
4. Centers for Disease Control and Prevention. Products - Vital Statistics Rapid Release - Provisional Drug Overdose Data. Published April 12, 2024. Accessed April 23, 2024. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.
5. Santo T, Campbell G, Gisev N, et al. Prevalence of mental disorders among people with opioid use disorder: A systematic review and meta-analysis. Drug Alcohol Depend. 2022; 238: 109551. doi:10.1016/j.drugalcdep.2022.109551.
6. Wakeman SE, Larochelle MR, Ameli O, et al. Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Netw Open. 2020; 3(2): e1920622. doi:10.1001/jamanetworkopen.2019.20622.
7. Weir MA, Slater J, Jandoc R, Koivu S, Garg AX, Silverman M. The risk of infective endocarditis among people who inject drugs: a retrospective, population-based time series analysis. CMAJ. 2019; 191(4): E93-E99. doi:10.1503/cmaj.180694.
8. Cranston K, Alpren C, John B, et al. Notes from the field: HIV diagnoses among persons who inject drugs - Northeastern Massachusetts, 2015-2018. MMWR Morb Mortal Wkly Rep. 2019; 68(10): 253-254. doi:10.15585/mmwr.mm6810a6.
9. Zibbell JE, Asher AK, Patel RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018; 108(2): 175-181. doi:10.2105/AJPH.2017.304132.
10. Fairley M, Humphreys K, Joyce VR, et al. Cost-effectiveness of treatments for opioid use disorder. JAMA Psychiatry. 2021; 78(7): 767-777. doi:10.1001/jamapsychiatry.2021.0247.
11. Lofwall MR, Fanucchi LC. Long-acting buprenorphine injectables: Opportunity to improve opioid use disorder treatment among rural populations. Prev Med. 2021; 152: 106756. doi:10.1016/j.ypmed.2021.106756.
12. La P, Je M, M P, et al. Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study. BMJ. 2020; 368:m772. doi:10.1136/bmj.m772.
13. Maurice D, Marc A, Oscar D, et al. Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus. Expert Opin Pharmacother. 2017; 18(18): 2003-2015. doi:10.1080/14656566.2017.1409722.
14. Priest KC, Gorfinkel L, Klimas J, Jones AA, Fairbairn N, McCarty D. Comparing Canadian and United States opioid agonist therapy policies. Int J Drug Policy. 2019; 74: 257-265. doi:10.1016/j.drugpo.2019.01.020.
15. Shulman M, Wai JM, Nunes EV. Buprenorphine treatment for opioid use disorder: An overview. CNS Drugs. 2019; 33(6): 567-580. doi:10.1007/s40263-019-00637-z.
16. Tompkins CNE, Neale J, Strang J. Opioid users’ willingness to receive prolonged-release buprenorphine depot injections for opioid use disorder. J Subst Abuse Treat. 2019; 104:64-71. doi:10.1016/j.jsat.2019.06.007.
17. Substance Abuse and Mental Health Services Administration. Buprenorphine. Published March 28, 2024. Accessed April 27, 2024. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/buprenorphine.
18. McMaster J, Abeysundera H. Effectiveness of long-acting buprenorphine - A systematic review. Australas Psychiatry. 2025; 33(2): 235-248. doi:10.1177/10398562241295872.
19. Korthuis PT, King C, Cook RR, et al. HIV clinic-based buprenorphine plus naloxone versus referral for methadone maintenance therapy for treatment of opioid use disorder in HIV clinics in Vietnam (BRAVO): an open-label, randomised, non-inferiority trial. Lancet HIV. 2021; 8(2): e67-e76. doi:10.1016/S2352-3018(20)30302-7.
20. Vietnam Administration for HIV/AIDS Control. Báo cáo kết quả công tác phòng, chống HIV/AIDS năm 2019 và nhiệm vụ trọng tâm năm 2020. Accessed July 28, 2025. https://vaac.gov.vn/upload/anh-bai-viet/tailieu/bao-cao-2019-gui-vpcp-da-nen.pdf?v=1.0.0.
21. PRISMA statement. PRISMA 2020 flow diagram. Accessed January 20, 2025. https://www.prisma-statement.org/prisma-2020-flow-diagram.
22. Frost M, Bailey GL, Lintzeris N, et al. Long-term safety of a weekly and monthly subcutaneous buprenorphine depot (CAM2038) in the treatment of adult out-patients with opioid use disorder. Addiction. 2019; 114(8): 1416-1426. doi:10.1111/add.14636.
23. Andorn AC, Haight BR, Shinde S, et al. Treating opioid use disorder with a monthly subcutaneous buprenorphine depot injection: 12-month safety, tolerability, and efficacy analysis. J Clin Psychopharmacol. 2020; 40(3): 231-239. doi:10.1097/JCP.0000000000001195.
24. Lee JD, Malone M, McDonald R, et al. Comparison of treatment retention of adults with opioid addiction managed with extended-release buprenorphine vs daily sublingual buprenorphine-naloxone at time of release from jail. JAMA Netw Open. 2021; 4(9): e2123032. doi:10.1001/jamanetworkopen.2021.23032.
25. Dunlop AJ, White B, Roberts J, et al. Treatment of opioid dependence with depot buprenorphine (CAM2038) in custodial settings. Addiction. 2022; 117(2): 382-391. doi:10.1111/add.15627.
26. Farrell M, Shahbazi J, Byrne M, et al. Outcomes of a single-arm implementation trial of extended-release subcutaneous buprenorphine depot injections in people with opioid dependence. Int J Drug Policy. 2022; 100: 103492. doi:10.1016/j.drugpo.2021.103492.
27. Macdonald T, Connor P, Edwards J, Hardy M, Kemp D, Johnston L. Real-world retention rates with a long-acting buprenorphine depot in opioid-dependent patients attending private clinics in Australia. Heroin Addict Relat Clin Probl. 2022; 24(2): 19-25
28. Nunes EV, Comer SD, Lofwall MR, et al. Extended-release injection vs sublingual buprenorphine for opioid use disorder with fentanyl use: A post hoc analysis of a randomized clinical trial. JAMA Netw Open. 2024; 7(6): e2417377. doi:10.1001/jamanetworkopen.2024.17377.
29. Farrell M, Shahbazi J, Chambers M, et al. 96-week retention in treatment with extended-release subcutaneous buprenorphine depot injections among people with opioid dependence: Extended follow-up after a single-arm trial. Int J Drug Policy. 2024; 127: 104390. doi:10.1016/j.drugpo.2024.104390.
30. Cheng A, Badolato R, Segoshi A, et al. Perceptions and experiences toward extended-release buprenorphine among persons leaving jail with opioid use disorders before and during COVID-19: an in-depth qualitative study. Addict Sci Clin Pract. 2022; 17(1): 4. doi:10.1186/s13722-022-00288-4.
31. Clay S, Treloar C, Degenhardt L, et al. “I just thought that was the best thing for me to do at this point”: Exploring patient experiences with depot buprenorphine and their motivations to discontinue. Int J Drug Policy. 2023; 115: 104002. doi:10.1016/j.drugpo.2023.104002.
32. Mariani JJ, Mahony A, Iqbal MN, Luo SX, Naqvi NH, Levin FR. Case series: Rapid induction onto long acting buprenorphine injection for high potency synthetic opioid users. Am J Addict. 2020; 29(4): 345-348. doi:10.1111/ajad.13018.
33. Mariani JJ, Mahony AL, Podell SC, et al. Open-label trial of a single-day induction onto buprenorphine extended-release injection for users of heroin and fentanyl. Am J Addict. 2021; 30(5): 470-476. doi:10.1111/ajad.13193.
34. Andrada E, Rodriguez M, Bandalan JH, Dangelo-Kemp D, Johnston L, Wilson H. Retention rates with monthly depot buprenorphine in general practice in Melbourne, Australia. Aust J Gen Pract. 2022; 51(6): 447-451. doi:10.31128/AJGP-07-21-6098.
35. Cotton AJ, Lo K, Kurtz FB, Waldbauer L. Extended-release buprenorphine outcomes among treatment resistant veterans. Am J Drug Alcohol Abuse. 2022; 48(3): 334-337. doi:10.1080/00952990.2021.1992773.
36. Stein MD, VanNoppen D, Herman DS, Anderson BJ, Conti M, Bailey GL. Retention in care for persons with opioid use disorder transitioning from sublingual to injectable buprenorphine. J Subst Abuse Treat. 2022; 136: 108661. doi:10.1016/j.jsat.2021.108661.
37. Galati BM, Wenzinger M, Rogers CE, Cooke E, Kelly JC. Buprenorphine extended-release treatment for opioid use disorder in the postpartum period. Obstet Gynecol. 2023; 142(5): 1148-1152. doi:10.1097/AOG.0000000000005319.
38. Iacono A, Wang T, Tadrous M, et al. Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: A population-based cohort study in Ontario, Canada. Drug Alcohol Depend. 2024; 254: 111032. doi:10.1016/j.drugalcdep.2023.111032.
39. Hammerslag LR, Talbert J, Slavova S, et al. Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder in Kentucky, before and after COVID-19 related buprenorphine access policy changes. J Subst Use Addict Treat. 2024; 164: 209391. doi:10.1016/j.josat.2024.209391.
40. Heil J, Salzman M, Hunter K, et al. Evaluation of an injectable monthly extended-release buprenorphine program in a low-barrier specialty addiction medicine clinic. J Subst Use Addict Treat. 2024; 156: 209183. doi:10.1016/j.josat.2023.209183.
41. Mlilo K, Fatema K, Poudel P, Harjanto R, Whitton G. Comparing the effectiveness of depot buprenorphine (buvidal injection) and buprenorphine/naloxone (suboxone) treatment following custody release - a retrospective cohort study. J Subst Use. 2024; 29(3): 257-265. doi:10.1080/14659891.2024.2342313.
42. Perdue M, Hosseini Ghomi R, Rees P, Arzubi E. 5-Day injectable extended-release buprenorphine initiation in non-opioid-tolerant individuals in a carceral setting: A case series. J Addict Med. 2024; 18(4): 335-339. doi:10.1097/ADM.0000000000001387.
43. Neptune A, Kaliamurthy S. The use of extended-release buprenorphine in the treatment of adolescent opioid use disorder: A case series. J Addict Med. 2025; 19(2): 150-154. doi:10.1097/ADM.0000000000001447.
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