Ziedonis Douglas M, Amass Leslie, Steinberg Marc, Woody George, Krejci Jonathan, Annon Jeffrey J, Cohen Allan J, Waite-O'Brien Nancy, Stine Susan M, McCarty Dennis, Reid Malcolm S, Brown Lawrence S, Maslansky Robert, Winhusen Theresa, Babcock Dean, Brigham Greg, Muir Joan, Orr Deborah, Buchan Betty J, Horton Terry, Ling Walter
National Institute on Drug Abuse Clinical Trials Network, University of Massachusetts Medical School, New England Node, Worcester, MA 01581, USA.
Drug Alcohol Depend. 2009 Jan 1;99(1-3):28-36. doi: 10.1016/j.drugalcdep.2008.06.016. Epub 2008 Sep 20.
Few studies in community settings have evaluated predictors, mediators, and moderators of treatment success for medically supervised opioid withdrawal treatment. This report presents new findings about these factors from a study of 344 opioid-dependent men and women prospectively randomized to either buprenorphine-naloxone or clonidine in an open-label 13-day medically supervised withdrawal study. Subjects were either inpatient or outpatient in community treatment settings; however not randomized by treatment setting. Medication type (buprenorphine-naloxone versus clonidine) was the single best predictor of treatment retention and treatment success, regardless of treatment setting. Compared to the outpatient setting, the inpatient setting was associated with higher abstinence rates but similar retention rates when adjusting for medication type. Early opioid withdrawal severity mediated the relationship between medication type and treatment outcome with buprenorphine-naloxone being superior to clonidine at relieving early withdrawal symptoms. Inpatient subjects on clonidine with lower withdrawal scores at baseline did better than those with higher withdrawal scores; inpatient subjects receiving buprenorphine-naloxone did better with higher withdrawal scores at baseline than those with lower withdrawal scores. No relationship was found between treatment outcome and age, gender, race, education, employment, marital status, legal problems, baseline depression, or length/severity of drug use. Tobacco use was associated with worse opioid treatment outcomes. Severe baseline anxiety symptoms doubled treatment success. Medication type (buprenorphine-naloxone) was the most important predictor of positive outcome; however the paper also considers other clinical and policy implications of other results, including that inpatient setting predicted better outcomes and moderated medication outcomes.
在社区环境中，很少有研究评估过医学监督下的阿片类药物戒断治疗取得成功的预测因素、调节因素和中介因素。本报告展示了一项针对344名阿片类药物依赖男性和女性的研究中关于这些因素的新发现。在一项为期13天的开放标签医学监督戒断研究中，这些受试者被前瞻性随机分配接受丁丙诺啡 - 纳洛酮或可乐定治疗。受试者为社区治疗环境中的住院患者或门诊患者；但未按治疗环境进行随机分组。无论治疗环境如何，药物类型（丁丙诺啡 - 纳洛酮与可乐定）是治疗依从性和治疗成功的唯一最佳预测因素。与门诊环境相比，在调整药物类型后，住院环境与更高的戒断率相关，但保留率相似。早期阿片类药物戒断严重程度介导了药物类型与治疗结果之间的关系，丁丙诺啡 - 纳洛酮在缓解早期戒断症状方面优于可乐定。基线时可乐定治疗的住院患者中，戒断评分较低者比评分较高者表现更好；接受丁丙诺啡 - 纳洛酮治疗的住院患者中，基线戒断评分较高者比评分较低者表现更好。未发现治疗结果与年龄、性别、种族、教育程度、就业情况、婚姻状况、法律问题、基线抑郁或药物使用时长/严重程度之间存在关联。吸烟与阿片类药物治疗效果较差有关。严重的基线焦虑症状使治疗成功率翻倍。药物类型（丁丙诺啡 - 纳洛酮）是积极结果的最重要预测因素；然而，本文还考虑了其他结果的其他临床和政策影响，包括住院环境预示着更好的结果并调节了药物治疗结果。
