Gossop M, Marsden J, Stewart D, Treacy S
Institute of Psychiatry, National Addiction Centre, Addiction Sciences Building, The Maudsley, 4 Windsor Walk, SE5 8AF, London, UK.
Drug Alcohol Depend. 2001 May 1;62(3):255-64. doi: 10.1016/s0376-8716(00)00211-8.
This paper provides a detailed analysis of the 2-year outcomes for 351 drug misusers allocated on an intention-to-treat basis to methadone maintenance or methadone reduction treatments. Both groups showed substantial reductions in their use of illicit drugs and in other outcome areas. However, whereas most methadone maintenance patients received maintenance, only about one third of those allocated to methadone reduction received methadone reduction, and many actually received a form of methadone maintenance. Reduction patients were more likely to receive low doses of methadone, and were less likely to remain in treatment. For maintenance patients, higher doses and retention in treatment were both associated with improvements in illicit heroin use at 2 years. For the reduction patients, the more rapidly the methadone was reduced, the worse the heroin use outcomes. For patients in both treatment conditions, reductions in heroin use were associated with improvements in other outcome areas. The more severely dependent patients showed better outcomes in methadone maintenance. Methadone reduction treatment processes were associated with poor outcomes, and many patients who were allocated to methadone reduction treatment did not receive reduction treatment as intended. This calls into question the appropriateness of either the initial treatment planning process or the treatment delivery process, or both. A clearer distinction should be made between methadone maintenance and methadone reduction. Treatment goals should be made explicit both to the patient and to the clinical staff at the start of treatment. We suggest the need for a reappraisal of the goals and procedures of methadone reduction treatment.
本文对351名药物滥用者进行了详细的两年期结果分析，这些患者按意向性治疗原则被分配接受美沙酮维持治疗或美沙酮递减治疗。两组在非法药物使用及其他结果方面均有显著减少。然而，大多数美沙酮维持治疗患者接受了维持治疗，而分配到美沙酮递减治疗组的患者中只有约三分之一接受了美沙酮递减治疗，许多人实际上接受的是某种形式的美沙酮维持治疗。递减治疗组患者更有可能接受低剂量美沙酮，且继续接受治疗的可能性较小。对于维持治疗组患者，较高剂量及继续接受治疗均与两年期非法海洛因使用的改善相关。对于递减治疗组患者，美沙酮减量越快，海洛因使用结果越差。对于两种治疗情况的患者，海洛因使用的减少均与其他结果领域的改善相关。依赖程度越严重的患者在美沙酮维持治疗中效果越好。美沙酮递减治疗过程与不良结果相关，许多被分配接受美沙酮递减治疗的患者并未按预期接受递减治疗。这对初始治疗规划过程或治疗实施过程，或两者的适宜性提出了质疑。应更明确地区分美沙酮维持治疗和美沙酮递减治疗。在治疗开始时，应向患者和临床工作人员明确治疗目标。我们建议有必要重新评估美沙酮递减治疗的目标和程序。
