Joseph H, Stancliff S, Langrod J
New York State Office of Alcoholism and Substance Abuse Services, 501 Seventh Avenue, 8th floor, New York, NY 10018, USA.
Mt Sinai J Med. 2000 Oct-Nov;67(5-6):347-64.
Methadone maintenance has been evaluated since its development in 1964 as a medical response to the post-World War II heroin epidemic in New York City. The findings of major early studies have been consistent. Methadone maintenance reduces and/or eliminates the use of heroin, reduces the death rates and criminality associated with heroin use, and allows patients to improve their health and social productivity. In addition, enrollment in methadone maintenance has the potential toreduce the transmission of infectious diseases associated with heroin injection, such as hepatitis and HIV. The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with heroin. A majority of patients require 80-120 mg/d of methadone, or more, to achieve these effects and require treatment for an indefinite period of time, since methadone maintenance is a corrective but not a curative treatment for heroin addiction. Lower doses may not be as effective or provide the blockade effect. Methadone maintenance has been found to be medically safe and nonsedating. It is also indicated for pregnant women addicted to heroin. Reviews issued by the Institute of Medicine and the National Institutes of Health have defined narcotic addiction as a chronic medical disorder and have claimed that methadone maintenance coupled with social services is the most effective treatment for this condition. These agencies recommend reducing governmental regulation to facilitate patients access to treatment. In addition, they recommend that the number of programs be expanded, and that new models of treatment be implemented,if the nationwide problem of addiction is to be brought under control. The National Institutes of Health also recommend that methadone maintenance be available to persons under legal supervision, such as probationers, parolees and the incarcerated. However, stigma and bias directed at the programs and the patients have hindered expansion and the effective delivery of services. Professional community leadership is necessary to educate the general public if these impediments are to be overcome.
自1964年美沙酮维持治疗法问世以来，它就作为对二战后纽约市海洛因泛滥的一种医学应对措施而受到评估。早期主要研究的结果一直是一致的。美沙酮维持治疗法减少和/或消除了海洛因的使用，降低了与海洛因使用相关的死亡率和犯罪率，并使患者能够改善健康状况和提高社会生产力。此外，参加美沙酮维持治疗法有潜力减少与海洛因注射相关的传染病传播，如肝炎和艾滋病毒。美沙酮维持治疗法的主要作用是缓解对麻醉品的渴望，抑制戒断综合征，并阻断与海洛因相关的欣快感。大多数患者需要每天80 - 120毫克或更多的美沙酮才能达到这些效果，并且需要接受无限期治疗，因为美沙酮维持治疗法是对海洛因成瘾的一种矫正而非治愈性治疗。较低剂量可能效果不佳或无法提供阻断作用。已发现美沙酮维持治疗法在医学上是安全的且无镇静作用。它也适用于对海洛因成瘾的孕妇。医学研究所和美国国立卫生研究院发布的综述将麻醉品成瘾定义为一种慢性医学疾病，并声称美沙酮维持治疗法与社会服务相结合是针对这种疾病最有效的治疗方法。这些机构建议减少政府监管以方便患者获得治疗。此外，他们建议扩大项目数量，并实施新的治疗模式，以便控制全国范围内的成瘾问题。美国国立卫生研究院还建议将美沙酮维持治疗法提供给处于法律监管之下的人员，如缓刑犯、假释犯和被监禁者。然而，针对这些项目和患者的污名化和偏见阻碍了项目的扩大和服务的有效提供。如果要克服这些障碍，专业的社区领导对于教育普通公众是必要的。
