Anglin M Douglas, Conner Bradley T, Annon Jeffery, Longshore Douglas
Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA, Los Angeles, CA 90025, USA.
Addiction. 2007 Sep;102(9):1432-42. doi: 10.1111/j.1360-0443.2007.01935.x.
To compare levo-alpha-acetylmethadol (LAAM) and methadone maintenance (MM) on treatment retention, drug use during treatment and at follow-up, and abstinence.
A two-group experimental design with patients assigned randomly (2:1) to receive fully subsidized LAAM or MM for 52 weeks.
A community clinic providing maintenance treatment in Los Angeles, California.
A total of 315 treatment-seeking patients willing to be assigned randomly to treatment condition; 289 (91.7%) were interviewed at 52 weeks.
LAAM or MM, plus ancillary services available to all patients. Medication dose varied according to clinical judgement.
Treatment retention and status at 52-week follow-up, weekly clinical urinalysis, self-reported drug use and research urinalysis on samples collected at follow-up.
LAAM participants were more likely to complete the planned 52 weeks (57.4%) than MM participants (46.2%) and were less likely to be discharged for arrest/incarceration. LAAM produced fewer during treatment clinic opiate-positive samples (M = 48.8) than MM (M = 62.3). Further, 24.4% on LAAM compared to 11.8% on MM were able to sustain at least 12 weeks of abstinence during the last 24 weeks of treatment. Opiate use at follow-up was lowest (50.9%) among LAAM participants in maintenance treatment. No adverse events, cardiological or otherwise, were observed with LAAM administration.
LAAM is an effective medication for the treatment of opiate dependence in community clinics with numerous behavioral and clinical advantages. LAAM is more effective than MM in promoting retention and extended reduction in and abstinence from opiate use while in treatment.
比较左旋-α-乙酰美沙醇（LAAM）和美沙酮维持治疗（MM）在治疗保留率、治疗期间及随访时的药物使用情况和戒断方面的效果。
两组实验设计，患者被随机（2:1）分配接受为期52周的全额补贴的LAAM或MM治疗。
加利福尼亚州洛杉矶的一家提供维持治疗的社区诊所。
共有315名寻求治疗的患者愿意被随机分配到治疗组；289名（91.7%）在52周时接受了访谈。
LAAM或MM，以及所有患者均可获得的辅助服务。药物剂量根据临床判断进行调整。
52周随访时的治疗保留率和状态、每周临床尿液分析、自我报告的药物使用情况以及随访时采集样本的研究尿液分析。
LAAM组参与者比MM组参与者更有可能完成计划的52周治疗（57.4%对46.2%），因被捕/监禁而出院的可能性更小。LAAM组在治疗期间诊所阿片类药物阳性样本数（M = 48.8）少于MM组（M = 62.3）。此外，在治疗的最后24周，LAAM组有24.4%的患者能够维持至少12周的戒断，而MM组为11.8%。在维持治疗的LAAM组参与者中，随访时阿片类药物使用率最低（50.9%）。使用LAAM未观察到不良事件，包括心脏或其他方面的不良事件。
LAAM是社区诊所治疗阿片类药物依赖的一种有效药物，具有诸多行为和临床优势。在促进治疗保留率以及在治疗期间延长减少阿片类药物使用和实现戒断方面，LAAM比MM更有效。
