Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, Vienna, 1400, Austria.
Prog Neuropsychopharmacol Biol Psychiatry. 2011 Mar 30;35(2):483-9. doi: 10.1016/j.pnpbp.2010.12.002. Epub 2010 Dec 10.
Methadone maintenance therapy (MMT) has been found effective in treating heroin addiction. Serious consideration should be given to the modality of methadone distribution, as it influences not only treatment outcome but the attitudes of policy makers and the community, too. On one hand, the choice of take-home methadone removes the need for daily attendance at a methadone clinic, which seems to improve patients' quality of life. On the other, this method, because of its lack of supervision and the absence of strict consumption monitoring, runs the risk of methadone misuse and diversion. In this study, we compared A) supervised daily consumption, B) contingent take-home incentives and C) non-contingent take-home in methadone maintenance in three groups of heroin-addicted patients attending three different MMT programmes. Retention rates at 12 months were significantly higher in contingent take-home patients (group B) than in those with supervised daily consumption (group A) and the non-contingent take-home (group C). Retention rates were higher in group A than in group C patients. Compared to patients in groups A and B, those in group C showed fewer negative urinalyses and higher rates of self-reported diversion and episodes of crime or violence. Results indicate a more positive outcomes following take-home methadone associated with behavioural incentives and other measures that aim to facilitate treatment compliance than those following daily supervised consumption. By contrast, non-contingent take-home methadone given to non-stabilized patients is associated with a high rate of diversion, along with more crime episodes and maladaptive behaviours.
美沙酮维持疗法（MMT）已被证实对治疗海洛因成瘾有效。美沙酮分发的方式应得到认真考虑，因为它不仅影响治疗效果，还影响政策制定者和社区的态度。一方面，选择带药回家可以减少每天到美沙酮诊所就诊的需要，这似乎提高了患者的生活质量。另一方面，这种方法由于缺乏监督和严格的消费监测，存在美沙酮滥用和转移的风险。在这项研究中，我们比较了三组海洛因成瘾患者在三种不同的美沙酮维持治疗方案中接受的 A）监督每日消费、B）附带带药回家奖励和 C）非附带带药回家。在 12 个月时，有附带带药回家奖励的患者（B 组）的保留率明显高于监督每日消费的患者（A 组）和非附带带药回家的患者（C 组）。A 组的保留率高于 C 组。与 A 组和 B 组的患者相比，C 组的患者尿检呈阴性的次数更少，自我报告的转移和犯罪或暴力事件的发生率更高。结果表明，与每日监督消费相比，带药回家与行为奖励和其他旨在促进治疗依从性的措施相关联，可产生更积极的结果。相比之下，非附带带药回家给予非稳定患者，与较高的转移率以及更多的犯罪事件和适应不良行为相关联。
