Sees K L, Delucchi K L, Masson C, Rosen A, Clark H W, Robillard H, Banys P, Hall S M
Department of Psychiatry, University of California, San Francisco 94143-0984, USA.
JAMA. 2000 Mar 8;283(10):1303-10. doi: 10.1001/jama.283.10.1303.
Despite evidence that methadone maintenance treatment (MMT) is effective for opioid dependence, it remains a controversial therapy because of its indefinite provision of a dependence-producing medication.
To compare outcomes of patients with opioid dependence treated with MMT vs an alternative treatment, psychosocially enriched 180-day methadone-assisted detoxification.
Randomized controlled trial conducted from May 1995 to April 1999.
Research clinic in an established drug treatment service.
Of 858 volunteers screened, 179 adults with diagnosed opioid dependence were randomized into the study; 154 completed 12 weeks of follow-up.
Patients were randomized to MMT (n = 91), which required 2 hours of psychosocial therapy per week during the first 6 months; or detoxification (n = 88), which required 3 hours of psychosocial therapy per week, 14 education sessions, and 1 hour of cocaine group therapy, if appropriate, for 6 months, and 6 months of (nonmethadone) aftercare services.
Treatment retention, heroin and cocaine abstinence (by self-report and monthly urinalysis), human immunodeficiency virus (HIV) risk behaviors (Risk of AIDS Behavior scale score), and function in 5 problem areas: employment, family, psychiatric, legal, and alcohol use (Addiction Severity Index), compared by intervention group.
Methadone maintenance therapy resulted in greater treatment retention (median, 438.5 vs 174.0 days) and lower heroin use rates than did detoxification. Cocaine use was more closely related to study dropout in detoxification than in MMT. Methadone maintenance therapy resulted in a lower rate of drug-related (mean [SD] at 12 months, 2.17 [3.88] vs 3.73 [6.86]) but not sex-related HIV risk behaviors and in a lower severity score for legal status (mean [SD] at 12 months, 0.05 [0.13] vs 0.13 [0.19]). There were no differences between groups in employment or family functioning or alcohol use. In both groups, monthly heroin use rates were 50% or greater, but days of use per month dropped markedly from baseline.
Our results confirm the usefulness of MMT in reducing heroin use and HIV risk behaviors. Illicit opioid use continued in both groups, but frequency was reduced. Results do not provide support for diverting resources from MMT into long-term detoxification.
尽管有证据表明美沙酮维持治疗（MMT）对阿片类药物依赖有效，但由于其无限期提供产生依赖的药物，它仍然是一种有争议的疗法。
比较接受MMT治疗的阿片类药物依赖患者与替代治疗（心理社会丰富的180天美沙酮辅助脱毒）的患者的治疗结果。
1995年5月至1999年4月进行的随机对照试验。
一家成熟的药物治疗服务机构中的研究诊所。
在858名接受筛查的志愿者中，179名被诊断为阿片类药物依赖的成年人被随机纳入研究；154人完成了12周的随访。
患者被随机分为MMT组（n = 91），在前6个月每周需要2小时的心理社会治疗；或脱毒组（n = 88），在前6个月每周需要3小时的心理社会治疗、14次教育课程以及酌情进行1小时的可卡因团体治疗，并在6个月后提供6个月的（非美沙酮）后续护理服务。
按干预组比较治疗保留率、海洛因和可卡因戒断情况（通过自我报告和每月尿液分析）、人类免疫缺陷病毒（HIV）风险行为（艾滋病风险行为量表评分）以及在5个问题领域的功能：就业、家庭、精神、法律和酒精使用（成瘾严重程度指数）。
与脱毒治疗相比，美沙酮维持治疗导致更高的治疗保留率（中位数分别为438.5天和174.0天）和更低的海洛因使用率。与MMT组相比，脱毒组中可卡因使用与研究退出的相关性更强。美沙酮维持治疗导致与药物相关的HIV风险行为发生率较低（12个月时均值[标准差]分别为2.17[3.88]和3.73[6.86]），但与性别相关的HIV风险行为发生率无差异，且法律状况的严重程度评分较低（12个月时均值[标准差]分别为0.05[0.13]和0.13[0.19]）。两组在就业、家庭功能或酒精使用方面无差异。在两组中，每月海洛因使用率均为50%或更高，但每月使用天数从基线水平显著下降。
我们的结果证实了MMT在减少海洛因使用和HIV风险行为方面的有效性。两组中非法阿片类药物使用仍在继续，但频率有所降低。结果不支持将资源从MMT转向长期脱毒治疗。
