Salsitz E A, Joseph H, Frank B, Perez J, Richman B L, Salomon N, Kalin M F, Novick D M
New York State Office of Alcoholism and Substance Abuse Services (OASAS), 501 Seventh Avenue, New York, NY 10018-5903, USA.
Mt Sinai J Med. 2000 Oct-Nov;67(5-6):388-97.
Methadone Medical Maintenance (MMM) was implemented in 1983 to enable socially rehabilitated methadone patients to be treated in the offices of private physicians rather than in the traditional clinic system. Over a period of 15 years, 158 methadone patients who fulfilled specific criteria within the clinic system entered this program in New York City. Participating patients reported to their physician once a month and received a one-month supply of methadone tablets rather than a one-day liquid dose in a bottle.
Of the 158 patients who entered this program, 132 (83.5%) were compliant with the regulations and proved to be treatable within the hospital-based private practices of internists participating in the program. Compliant MMM patients found it easier to improve their employment status and business situations, finish their educations, and normalize their lives in MMM as opposed to the traditional clinic system because they had simplified reporting schedules and fewer clinical restrictions. Twelve (8%) compliant patients were able to successfully withdraw from methadone after an average of 17.7 years of treatment in both the traditional clinics and MMM. Twenty compliant patients (13%) died from a variety of causes, 40% of which were related to cigarette smoking. None of the deaths were attributable to long-term methadone treatment. Other causes of death included hepatitis C, AIDS, cancer, homicide, complications of morbid obesity and meningitis.
The 26 noncompliant patients (16.5%) were referred back to their clinics for continued treatment or were discharged for failure to report as directed. A major cause of failure in MMM was abuse of crack/cocaine.
Stigma concerning enrollment in methadone treatment was a major social issue that patients faced. Many refused to inform employers, members of their families, friends, and other physicians who treated them for a various of conditions that they were methadone patients. The methadone medical maintenance physician, therefore, functions as a medical ombudsman for the patient, educating other physicians who treat the patient about methadone maintenance and its applicability to the patient. Our results can serve as a model for the expansion of office-based MMM treatment.
美沙酮医疗维持治疗（MMM）于1983年实施，旨在让经过社会康复的美沙酮患者能够在私人医生诊所而非传统诊所系统接受治疗。在15年的时间里，纽约市有158名在诊所系统内符合特定标准的美沙酮患者进入了该项目。参与项目的患者每月向他们的医生报到一次，并领取一个月用量的美沙酮片剂，而不是在瓶子里领取一天用量的液体剂型。
在进入该项目的158名患者中，132名（83.5%）遵守规定，且在参与该项目的内科医生基于医院的私人诊所中被证明是可治疗的。与传统诊所系统相比，遵守规定的MMM患者发现，由于他们简化了报到时间表且临床限制较少，因此更容易改善就业状况和商业情况、完成学业并使生活正常化。12名（8%）遵守规定的患者在传统诊所和MMM平均接受了17.7年的治疗后成功停用了美沙酮。20名遵守规定的患者（13%）因各种原因死亡，其中40%与吸烟有关。没有一例死亡可归因于长期美沙酮治疗。其他死亡原因包括丙型肝炎、艾滋病、癌症、凶杀、病态肥胖并发症和脑膜炎。
26名不遵守规定的患者（16.5%）被转回他们的诊所继续治疗，或因未按指示报到而被出院。MMM治疗失败的一个主要原因是滥用强效可卡因。
参与美沙酮治疗所面临的污名是患者面临的一个主要社会问题。许多人拒绝告知雇主、家人、朋友以及为他们治疗各种疾病的其他医生他们是美沙酮患者。因此，美沙酮医疗维持治疗医生充当患者的医疗监察员，向治疗该患者的其他医生介绍美沙酮维持治疗及其对该患者的适用性。我们的结果可为扩大基于办公室的MMM治疗提供一个范例。
