Bell James, Burrell Tracy, Indig Devon, Gilmour Stuart
The Langton Centre, 591 South Dowling St, Surry Hills, NSW 2010, Australia.
Drug Alcohol Depend. 2006 Jan 4;81(1):55-61. doi: 10.1016/j.drugalcdep.2005.05.010. Epub 2005 Jul 1.
There are few descriptions of patterns of long-term participation in methadone treatment. There has been progressive expansion of methadone maintenance treatment (MMT) in Australia in the last 15 years, and by international standards Australia has a high participation rate in MMT, and has accumulated extensive data on participation.
(1) To analyse predictors of retention in treatment (a proxy measure of treatment effectiveness) in three cohorts of people entering public and private methadone treatment, in 1990, 1995, and 2000 in the state of New South Wales (NSW), and to compare retention rates with those reported from recent clinical trials; and (2) to describe the pattern of participation in subsequent treatment and predictors of re-entry.
Sequential first admissions to MMT for the month of February during 1990, 1995, and 2000, were identified from the NSW Health database. Initial treatment setting (public or private) was identified. Pattern of subsequent participation in treatment of all subjects was also extracted. Descriptive statistics were generated, and predictors of retention in treatment and re-entry to treatment were analysed.
The sample comprised 342 subjects commencing in private and 135 in public settings. Retention did not differ between settings. At 6 months, 51% in the current study were retained, compared to 48% in pooled clinical trials from Australia. There was a significant cohort effect; at 3 months retention was significantly better in the 1990 cohort, but by 12 months, differences between the year-cohorts were not statistically significant. Most people who left treatment dropped out; two-thirds subsequently re-entered MMT, often having multiple episodes. Participation in non-continuous treatment was around 45% for the 5 years after first entering treatment. Using multiple logistic regression, the significant predictors of re-entry to treatment were age, and duration of first treatment episode; specifically, older people and those with >12 months continuous treatment were significantly less likely to re-enter.
Retention in treatment in practice, across a range of settings, appears comparable to treatment delivered in clinical trials. Participants cycle in and out of treatment, and this recycling appears to have increased as the program has expanded and access to treatment has increased.
关于长期参与美沙酮治疗模式的描述较少。在过去15年中，澳大利亚的美沙酮维持治疗（MMT）一直在逐步扩大，并且按照国际标准，澳大利亚在MMT方面的参与率很高，并且积累了关于参与情况的广泛数据。
（1）分析1990年、1995年和2000年在新南威尔士州（NSW）进入公立和私立美沙酮治疗的三组人群中治疗留存率（治疗效果的一种替代指标）的预测因素，并将留存率与近期临床试验报告的留存率进行比较；（2）描述后续治疗的参与模式以及再次进入治疗的预测因素。
从新南威尔士州卫生数据库中识别出1990年、1995年和2000年2月首次连续进入MMT治疗的患者。确定初始治疗机构（公立或私立）。还提取了所有受试者后续的治疗参与模式。生成描述性统计数据，并分析治疗留存率和再次进入治疗的预测因素。
样本包括342名在私立机构开始治疗的受试者和135名在公立机构开始治疗的受试者。不同机构之间的留存率没有差异。在本研究中，6个月时的留存率为51%，而澳大利亚汇总的临床试验中的留存率为48%。存在显著的队列效应；3个月时，1990年队列的留存率显著更好，但到12个月时，不同年份队列之间的差异无统计学意义。大多数离开治疗的人退出了；三分之二的人随后再次进入MMT治疗，且常常有多次治疗经历。首次进入治疗后的5年中，参与非连续治疗的比例约为45%。使用多元逻辑回归分析，再次进入治疗的显著预测因素是年龄和首次治疗疗程的时长；具体而言，年龄较大者和连续治疗超过12个月者再次进入治疗的可能性显著较低。
在各种环境下，实际治疗中的留存率似乎与临床试验中的治疗效果相当。参与者在治疗中循环进出，并且随着项目的扩大和治疗可及性的增加，这种循环似乎有所增加。
