Gibson Amy, Degenhardt Louisa, Mattick Richard P, Ali Robert, White Jason, O'Brien Susannah
National Drug and Alcohol Research Centre, UNSW, Australia.
Addiction. 2008 Mar;103(3):462-8. doi: 10.1111/j.1360-0443.2007.02090.x. Epub 2008 Jan 8.
To (i) examine the predictors of mortality in a randomized study of methadone versus buprenorphine maintenance treatment; (ii) compare the survival experience of the randomized subject groups; and (iii) describe the causes of death.
Ten-year longitudinal follow-up of mortality among participants in a randomized trial of methadone versus buprenorphine maintenance treatment.
Recruitment through three clinics for a randomized trial of buprenorphine versus methadone maintenance.
A total of 405 heroin-dependent (DSM-IV) participants aged 18 years and above who consented to participate in original study.
Baseline data from original randomized study; dates and causes of death through data linkage with Births, Deaths and Marriages registries; and longitudinal treatment exposure via State health departments. Predictors of mortality examined through survival analysis.
There was an overall mortality rate of 8.84 deaths per 1000 person-years of follow-up and causes of death were comparable with the literature. Increased exposure to episodes of opioid treatment longer than 7 days reduced the risk of mortality; there was no differential mortality among methadone versus buprenorphine participants. More dependent, heavier users of heroin at baseline had a lower risk of death, and also higher exposure to opioid treatment. Older participants randomized to buprenorphine treatment had significantly improved survival. Aboriginal or Torres Strait Islander participants had a higher risk of death.
Increased exposure to opioid maintenance treatment reduces the risk of death in opioid-dependent people. There was no differential reduction between buprenorphine and methadone. Previous studies suggesting differential effects may have been affected by biases in patient selection.
（i）在一项美沙酮与丁丙诺啡维持治疗的随机研究中，考察死亡率的预测因素；（ii）比较随机分组的各受试者组的生存情况；（iii）描述死亡原因。
对一项美沙酮与丁丙诺啡维持治疗随机试验的参与者进行为期十年的死亡率纵向随访。
通过三家诊所招募人员，进行丁丙诺啡与美沙酮维持治疗的随机试验。
共有405名年龄在18岁及以上、符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的海洛因依赖参与者，他们同意参与原研究。
原随机研究的基线数据；通过与出生、死亡和婚姻登记处的数据关联获取死亡日期和原因；通过州卫生部门获取纵向治疗暴露情况。通过生存分析考察死亡率的预测因素。
随访期间每1000人年的总死亡率为8.84例死亡，死亡原因与文献报道相当。接受超过7天阿片类药物治疗的次数增加可降低死亡风险；美沙酮组与丁丙诺啡组参与者的死亡率无差异。基线时海洛因依赖程度更高、使用量更大的使用者死亡风险较低，且接受阿片类药物治疗的暴露时间也更长。随机接受丁丙诺啡治疗的老年参与者生存情况有显著改善。原住民或托雷斯海峡岛民参与者死亡风险更高。
增加阿片类药物维持治疗的暴露时间可降低阿片类药物依赖者的死亡风险。丁丙诺啡与美沙酮之间在降低死亡风险方面无差异。先前表明存在差异效应的研究可能受到了患者选择偏倚的影响。
