Guichard Anne, Lert France, Calderon Christine, Gaigi Hind, Maguet Olivier, Soletti Jérôme, Brodeur Jean-Marc, Richard Lucie, Benigeri Mike, Zunzunegui Maria-Victoria
French Institute of Health and Medical Research (INSERM U88), Hôpital National de Saint-Maurice, St-Maurice, France.
Addiction. 2003 Nov;98(11):1585-97. doi: 10.1046/j.1360-0443.2003.00500.x.
To evaluate the associations between methadone and high-dose buprenorphine maintenance treatment and illicit drug use and injection among drug users in France.
A cross-sectional study. Data were gathered using a questionnaire administered containing closed-ended questions.
Drug dependence clinics (DDC) and general practitioners' (GPs) offices in three French cities.
Drug users undergoing maintenance treatment with methadone (n = 197) and buprenorphine (n = 142).
Interviews covered the use of illicit drugs (heroin, cocaine or crack) and injection practices (illicit drugs and/or substitution drugs) during the last month, current treatment modalities, socio-demographic and health characteristics. Bivariate analysis and multivariate logistic regressions were conducted.
Overall, 35.4% of respondents (34.5% in the methadone group, 36.6% in the buprenorphine group, P= 0.69) had used at least one illicit drug, 25.7% reported having injected drugs and 15.3% had injected the substitution drug. Injection was more common among buprenorphine-maintained individuals (40.1%) than among users on methadone (15.2%) (P < 0.01). Multivariate analyses indicate that the type of substitution drug (buprenorphine versus methadone) was not associated with illicit drug use (OR = 1.1; 95% CI = 0.7-1.8). In the buprenorphine group, injection was related independently to social situation, as measured by housing (unstable versus stable housing, OR = 4.3; 95% CI = 1.6-11.5), but this was not the case in the methadone group. The risk of injection increased with buprenorphine dosage (high/low dosage OR = 6.2; 95% CI = 2.0-19.7), but this association was not observed in the methadone group.
Further studies comparing the benefits of these two types of treatment should be carried out, taking outcomes such as physical health, mental health and social functioning into consideration.
评估美沙酮和高剂量丁丙诺啡维持治疗与法国吸毒者非法药物使用及注射之间的关联。
一项横断面研究。通过包含封闭式问题的问卷收集数据。
法国三个城市的药物依赖诊所（DDC）和全科医生（GP）办公室。
接受美沙酮维持治疗的吸毒者（n = 197）和丁丙诺啡维持治疗的吸毒者（n = 142）。
访谈内容包括过去一个月内非法药物（海洛因、可卡因或快克）的使用情况以及注射行为（非法药物和/或替代药物）、当前治疗方式、社会人口统计学和健康特征。进行了双变量分析和多变量逻辑回归分析。
总体而言，35.4%的受访者（美沙酮组为34.5%，丁丙诺啡组为36.6%，P = 0.69）使用过至少一种非法药物，25.7%的受访者报告曾注射过药物，15.3%的受访者曾注射过替代药物。在接受丁丙诺啡维持治疗的个体中，注射更为常见（40.1%），高于接受美沙酮治疗的使用者（15.2%）（P < 0.01）。多变量分析表明，替代药物类型（丁丙诺啡与美沙酮）与非法药物使用无关（比值比 = 1.1；95%置信区间 = 0.7 - 1.8）。在丁丙诺啡组中，注射行为与社会状况独立相关，以住房情况衡量（不稳定住房与稳定住房，比值比 = 4.3；95%置信区间 = 1.6 - 11.5），但在美沙酮组中并非如此。注射风险随丁丙诺啡剂量增加而增加（高/低剂量比值比 = 6.2；95%置信区间 = 2.0 - 19.7），但在美沙酮组中未观察到这种关联。
应开展进一步研究比较这两种治疗方式的益处，同时考虑身体健康、心理健康和社会功能等结果。
