King Van L, Kidorf Michael S, Stoller Kenneth B, Schwartz Robert, Kolodner Kenneth, Brooner Robert K
The Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
J Subst Abuse Treat. 2006 Dec;31(4):385-93. doi: 10.1016/j.jsat.2006.05.014. Epub 2006 Aug 14.
Methadone medical maintenance (MMM) reduces the reporting schedule for stable and well-functioning methadone maintenance patients to once a month, with counseling provided by medical staff. We report on the 12-month outcomes of 92 highly stable methadone maintenance patients randomly assigned to one of three study conditions: routine care, MMM at the methadone maintenance program, and MMM at a physician's office. Methadone medical maintenance patients received a 28-day supply of methadone, whereas routine care patients received five or six take-home methadone doses each week. All patients performed a medication recall once a month and submitted two urine samples each month. An adaptive stepped-care system of treatment intensification was used for patients who failed recall or who had drug-positive urine specimens. Seventy-seven patients completed the 12-month study period. Dropout was caused primarily by problems with handling methadone and disliking the recall frequency. There were low rates of drug use or failed medication recall. Treatment satisfaction was high in all groups, but the MMM patients initiated more new employment or family/social activities than did routine care patients over the study period. The stepped-care approach was well tolerated and matched patients to an appropriate step of service within a continuum of treatment intensity.
美沙酮维持治疗（MMM）将病情稳定、功能良好的美沙酮维持治疗患者的报告频率减至每月一次，并由医务人员提供咨询服务。我们报告了92名高度稳定的美沙酮维持治疗患者的12个月治疗结果，这些患者被随机分配至三种研究条件之一：常规护理、在美沙酮维持治疗项目中接受MMM，以及在医生办公室接受MMM。接受MMM的患者获得了为期28天的美沙酮供应，而接受常规护理的患者每周领取五或六次美沙酮带回家服用剂量。所有患者每月进行一次用药回忆，并每月提交两份尿液样本。对于回忆失败或尿液样本药物检测呈阳性的患者，采用了适应性逐步强化治疗系统。77名患者完成了12个月的研究期。退出主要是由于美沙酮处理问题和不喜欢回忆频率。药物使用或用药回忆失败的发生率较低。所有组的治疗满意度都很高，但在研究期间，接受MMM的患者比接受常规护理的患者开始了更多新的工作或家庭/社交活动。逐步强化治疗方法耐受性良好，能使患者在连续的治疗强度范围内匹配到适当的服务级别。
