Childress A R, McLellan A T, Woody G E, O'Brien C P
Department of Psychiatry, University of Pennsylvania, Philadelphia.
NIDA Res Monogr. 1991;106:167-77.
Although methadone maintenance is a treatment modality with the demonstrated ability to reduce IV drug use and subsequent AIDS risk, methadone maintenance programs vary widely in their effectiveness: Demographically similar patient samples show profound improvements in some programs and little change in others. This suggests that programmatic factors rather than patient variables or sheer availability of methadone may be important active ingredients in effective methadone maintenance. The AIDS epidemic has led to the demand for increased availability of methadone, with suggested elimination of counseling, urine contingencies, and other rehabilitative services in an effort to fund additional "methadone-only" treatment slots. The data reviewed here, including preliminary results from a study examining the effectiveness of "minimal" methadone services, suggest that merely increasing the availability of methadone in the absence of administrative counseling, and rehabilitative services may not adequately protect the majority of patients from continued drug use and the risk of AIDS.
尽管美沙酮维持治疗是一种已被证明有能力减少静脉注射吸毒及后续艾滋病风险的治疗方式，但美沙酮维持治疗项目的效果差异很大：在人口统计学特征相似的患者样本中，一些项目显示出显著改善，而另一些项目则变化甚微。这表明，项目因素而非患者变量或美沙酮的单纯可及性，可能是有效美沙酮维持治疗中的重要活性成分。艾滋病疫情导致对增加美沙酮可及性的需求，有人建议取消咨询、尿液检测及其他康复服务，以便为更多“仅使用美沙酮”的治疗床位提供资金。此处回顾的数据，包括一项检验“最低限度”美沙酮服务效果的研究的初步结果，表明在缺乏管理咨询和康复服务的情况下单纯增加美沙酮的可及性，可能无法充分保护大多数患者避免持续吸毒及感染艾滋病的风险。
