Bovasso Gregory, Cacciola John
Community College of Philadelphia, 1700 Spring Garden St, Philadelphia, PA 19130, USA.
J Behav Health Serv Res. 2003 Jul-Sep;30(3):290-303. doi: 10.1007/BF02287318.
The aim of the study is to predict long-term outcomes of methadone maintenance (MM), other than continued heroin use, on the basis of drug use occurring early in MM treatment. In previous research, the weak association of initial drug use during MM with measures of rehabilitation status may be due to the use of measures that do not differentiate trends in different types of drug use. In the present study, 222 patients who completed 6 months of MM were assessed at program intake, evaluated for opiates and cocaine in the first 6 months of treatment, and given a follow-up assessment 2 years after treatment entry. The intake status of the patients was assessed using the Addiction Severity Index. Opiate and cocaine use during the first 6 months of MM was assessed by urine toxicology. Outcomes were assessed using a structured interview and official criminal records at follow-up. Cluster analysis of urine toxicologies during treatment identified 3 trajectory classes of MM patients: (A) variably high levels of opiate use, but consistently low cocaine use; (B) low and diminishing opiate and cocaine use; and (C) consistently high cocaine use, with diminishing opiate use. In an 18-month period, after these trends were observed, Cluster C had significantly more criminal charges than Cluster B had (3 times as many), but not significantly more than those of Cluster A. Clusters A and B did not differ significantly in criminal charges. Regardless of cluster membership, subjects with increasing levels of cocaine use in the first 6 months of MM had more hospitalizations for drug and alcohol problems during the follow-up period than subjects without increasing levels of cocaine use had. The results provide evidence of negative sequelae of cocaine use during MM that underscore the importance of clinical efforts to reduce levels of cocaine and other nonopiate drug use by MM patients.
本研究的目的是基于美沙酮维持治疗（MM）早期出现的药物使用情况，预测除持续使用海洛因以外的MM长期治疗效果。在先前的研究中，MM期间初始药物使用与康复状态指标之间的弱关联可能是由于所使用的指标未区分不同类型药物使用的趋势。在本研究中，对222名完成了6个月MM治疗的患者在项目入组时进行了评估，在治疗的前6个月对其鸦片类药物和可卡因使用情况进行了评估，并在治疗开始2年后进行了随访评估。使用成瘾严重程度指数评估患者的入组状态。通过尿液毒理学评估MM前6个月期间的鸦片类药物和可卡因使用情况。在随访时使用结构化访谈和官方犯罪记录评估治疗效果。对治疗期间尿液毒理学进行聚类分析，确定了MM患者的3种轨迹类别：（A）鸦片类药物使用水平高低不一，但可卡因使用一直较低；（B）鸦片类药物和可卡因使用量低且逐渐减少；（C）可卡因使用一直较高，鸦片类药物使用量逐渐减少。在观察到这些趋势后的18个月期间，C组的刑事指控明显多于B组（多出3倍），但并不显著多于A组。A组和B组在刑事指控方面没有显著差异。无论属于哪一组，在MM前6个月可卡因使用量增加的受试者在随访期间因药物和酒精问题住院的次数都比可卡因使用量未增加的受试者多。结果提供了MM期间使用可卡因产生负面后果的证据，强调了临床努力降低MM患者可卡因及其他非鸦片类药物使用水平的重要性。
