Rehm J, Gschwend P, Steffen T, Gutzwiller F, Dobler-Mikola A, Uchtenhagen A
Addiction Research Institute, CH 8031, Zurich, Switzerland.
Lancet. 2001 Oct 27;358(9291):1417-23. doi: 10.1016/S0140-6736(01)06529-1.
Heroin-assisted substitution treatment for severely opioid-dependent drug users has been available in Switzerland since 1994. Our aim was to ascertain the feasibility, safety, and efficacy of this treatment.
We did a cohort study in 21 community outpatient treatment centres. We assessed 1969 opioid-dependent drug users, who began heroin-assisted substitution treatment between January, 1994, and December, 2000, to ascertain admission and discharge patterns, and patient characteristics. We also followed up a subset of 237 patients who began treatment between Jan 1, 1994, and March 31, 1995, and who stayed with the programme for at least 18 months. We used questionnaires, interviews, and medical examinations done at entry and after 6, 12, and 18 months to assess somatic and mental health, social integration, and treatment outcomes.
More than 70% (1378) of patients remained in treatment for more than a year. Treatment showed positive effects with respect to health and social outcomes. A long stay in treatment was related to a higher chance of starting abstinence-oriented therapy than a short stay.
Heroin-assisted substitution treatment might be an effective option for chronically addicted patients for whom other treatments have failed.
自1994年起，瑞士就为重度阿片类药物依赖的吸毒者提供海洛因辅助替代治疗。我们的目的是确定这种治疗的可行性、安全性和有效性。
我们在21个社区门诊治疗中心开展了一项队列研究。我们评估了1969名在1994年1月至2000年12月期间开始接受海洛因辅助替代治疗的阿片类药物依赖吸毒者，以确定其入院和出院模式以及患者特征。我们还对1994年1月1日至1995年3月31日期间开始治疗且在该项目中至少停留18个月的237名患者进行了随访。我们使用在入组时以及6个月、12个月和18个月后进行的问卷调查、访谈和医学检查来评估躯体和心理健康、社会融入情况以及治疗结果。
超过70%（1378名）的患者接受治疗超过一年。治疗在健康和社会结果方面显示出积极效果。与短期治疗相比，长期治疗的患者开始接受戒断导向治疗的可能性更高。
对于其他治疗方法无效的慢性成瘾患者，海洛因辅助替代治疗可能是一种有效的选择。
