Mattick R P, Breen C, Kimber J, Davoli M
National Drug and Alcohol Research Centre, University of New South Wales, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
Cochrane Database Syst Rev. 2003(2):CD002209. doi: 10.1002/14651858.CD002209.
Methadone maintenance was the first widely used form of opioid replacement therapy developed to treat heroin dependence, and it remains the best-researched treatment for this problem. Despite the widespread use of methadone in maintenance treatment for opioid dependence in many countries, it is a controversial treatment whose effectiveness has been disputed.
To evaluate the effects of methadone maintenance treatment (MMT) compared with treatments that did not involve opioid replacement therapy (i.e., detoxification, offer of drug-free rehabilitation, placebo medication, wait-list controls) for opioid dependence.
We searched all the following databases up to 2001: Cochrane Drugs and Alcohol Review Group Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Current Contents, Psychlit, CORK [www. state.vt.su/adap/cork], Alcohol and Drug Council of Australia (ADCA) [www.adca.org.au], Australian Drug Foundation (ADF-VIC) [www.adf.org.au], Centre for Education and Information on Drugs and Alcohol (CEIDA) [www.ceida.net.au], Australian Bibliographic Network (ABN), and Library of Congress databases, available NIDA monographs and the College on Problems of Drug Dependence Inc. proceedings, the reference lists of all identified studies and published reviews; authors of identified RCTs were asked about other published or unpublished relevant RCTs.
All randomised controlled clinical trials of methadone maintenance therapy compared with either placebo maintenance or other non-pharmacological therapy for the treatment of opioid dependence.
Reviewers evaluated the papers separately and independently, rating methodological quality of concealment of allocation, data were extracted independently for meta-analysis and double-entered.
Six studies met the criteria for inclusion in this review, all were randomised clinical trials, two were double-blind. There were a total number of 954 participants. The method of concealment of allocation was inadequate in one study, not clearly described in four studies, but adequate in a sixth study. Based on the meta-analysis, methadone appeared statistically significantly more effective than non-pharmacological approaches in retaining patient in treatment (3 RCTs, RR=3.05; 95%CI: 1.75-5.35) and in the suppression of heroin use (3 RCTs, RR=0.32; 95%CI: 0.23-0.44), but not statistically in criminal activity (3 RCTs, RR=0.39; 95%CI: 0.12-1.25).
REVIEWER'S CONCLUSIONS: Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy. It does not show a statistically significant superior effect on criminal activity.
美沙酮维持治疗是为治疗海洛因依赖而开发的第一种广泛使用的阿片类药物替代疗法，并且它仍然是针对该问题研究最充分的治疗方法。尽管美沙酮在许多国家的阿片类药物依赖维持治疗中广泛使用，但它是一种有争议的治疗方法，其有效性一直存在争议。
评估美沙酮维持治疗（MMT）与不涉及阿片类药物替代疗法的治疗方法（即脱毒、提供无药物康复、安慰剂药物治疗、等待名单对照）相比，对阿片类药物依赖的效果。
我们检索了截至2001年的所有以下数据库：Cochrane药物与酒精综述组注册库、Cochrane对照试验注册库、MEDLINE、EMBASE、《现刊目次》、Psychlit、CORK [www.state.vt.su/adap/cork]、澳大利亚酒精与药物理事会（ADCA）[www.adca.org.au]、澳大利亚药物基金会（ADF - VIC）[www.adf.org.au]、药物与酒精教育与信息中心（CEIDA）[www.ceida.net.au]、澳大利亚书目网络（ABN）以及美国国会图书馆数据库、现有的美国国立药物滥用研究所专论和药物依赖问题学院会议论文集、所有已识别研究和已发表综述的参考文献列表；询问已识别随机对照试验的作者关于其他已发表或未发表的相关随机对照试验。
所有比较美沙酮维持治疗与安慰剂维持治疗或其他非药物疗法治疗阿片类药物依赖的随机对照临床试验。
评审人员分别独立评估论文，对分配隐藏的方法学质量进行评分，数据独立提取用于荟萃分析并进行双录入。
六项研究符合本综述的纳入标准，均为随机临床试验，两项为双盲试验。共有954名参与者。一项研究中分配隐藏方法不充分，四项研究未明确描述，但第六项研究中分配隐藏方法充分。基于荟萃分析，在使患者坚持治疗方面，美沙酮在统计学上比非药物方法显著更有效（3项随机对照试验，相对危险度RR = 3.05；95%置信区间：1.
