Wittchen Hans-Ulrich, Apelt Sabine M, Soyka Michael, Gastpar Markus, Backmund Markus, Gölz Jörg, Kraus Michael R, Tretter Felix, Schäfer Martin, Siegert Jens, Scherbaum Norbert, Rehm Jürgen, Bühringer Gerhard
Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzerstrasse 46, 01187 Dresden, Germany.
Drug Alcohol Depend. 2008 Jun 1;95(3):245-57. doi: 10.1016/j.drugalcdep.2008.01.015. Epub 2008 Mar 11.
In many countries, buprenorphine and methadone are licensed for the maintenance treatment (MT) of opioid dependence. Despite many short-term studies, little is known about the long-term (12-month) effects of these treatments in different settings, i.e. primary care-based (PMC) and specialized substitution centers (SSCs).
To describe over a period of 12 months: (1) mortality, retention and abstinence rates; (2) changes in concomitant drug use, somatic and mental health; and (3) to explore differences between different types of provider settings.
12-Month prospective-longitudinal naturalistic study with four waves of assessment in a prevalence sample of N=2694 maintenance patients, recruited from a nationally representative sample of N=223 substitution physicians.
The 12-month retention rate was 75%; the mortality rate 1.1%. 4.1% of patients became "abstinent" during follow-up. 7% were referred to drug-free addiction treatment. Concomitant drug use decreased and somatic health status improved. No significant improvements were observed for mental health and quality of life. When controlling for initial severity, small PMC settings revealed better retention, abstinence and concomitant drug use rates.
The study underlines the overall 12-month effectiveness of various forms of agonist MT. Findings reveal relatively high retention rates, low mortality rates, and improvements in most 12-month outcome domains, except for mental health and quality of life. PMC settings appear to be a good additional option to improve access to MTs.
在许多国家，丁丙诺啡和美沙酮被批准用于阿片类药物依赖的维持治疗（MT）。尽管有许多短期研究，但对于这些治疗在不同环境下（即基于初级保健的治疗[PMC]和专业替代中心[SSC]）的长期（12个月）效果知之甚少。
描述为期12个月的情况：（1）死亡率、留存率和戒断率；（2）伴随药物使用、躯体和心理健康的变化；（3）探讨不同类型医疗机构之间的差异。
对从N = 223名替代治疗医生的全国代表性样本中招募的N = 2694名维持治疗患者的患病率样本进行为期12个月的前瞻性纵向自然观察研究，共进行四轮评估。
12个月的留存率为75%；死亡率为1.1%。4.1%的患者在随访期间实现“戒断”。7%的患者被转介接受无药物成瘾治疗。伴随药物使用减少，躯体健康状况改善。心理健康和生活质量未观察到显著改善。在控制初始严重程度后，小型PMC机构的留存率、戒断率和伴随药物使用率更高。
该研究强调了各种形式的激动剂维持治疗在12个月内的总体有效性。研究结果显示留存率相对较高，死亡率较低，除心理健康和生活质量外，大多数12个月的结局指标均有所改善。PMC机构似乎是增加维持治疗可及性的一个良好选择。
