苯二氮䓬类药物在美沙酮治疗计划患者中的使用和滥用。
Benzodiazepine use and misuse among patients in a methadone program.
机构信息
Center for Integrative Medicine University of Maryland School of Medicine 520 W, Lombard St, East Hall, Baltimore, MD 21201, USA.
出版信息
BMC Psychiatry. 2011 May 19;11:90. doi: 10.1186/1471-244X-11-90.
BACKGROUND
Benzodiazepines (BZD) misuse is a serious public health problem, especially among opiate-dependent patients with anxiety enrolled in methadone program because it puts patients at higher risk of life-threatening multiple drug overdoses. Both elevated anxiety and BZD misuse increase the risk for ex-addicts to relapse. However, there is no recent study to assess how serious the problem is and what factors are associated with BZD misuse. This study estimates the prevalence of BZD misuse in a methadone program, and provides information on the characteristics of BZD users compared to non-users.
METHODS
An anonymous survey was carried out at a methadone program in Baltimore, MD, and all patients were invited to participate through group meetings and fliers around the clinic on a voluntary basis. Of the 205 returned questionnaires, 194 were complete and entered into final data analysis. Those who completed the questionnaire were offered a $5 gift card as an appreciation.
RESULTS
47% of the respondents had a history of BZD use, and 39.8% used BZD without a prescription. Half of the BZD users (54%) started using BZD after entering the methadone program, and 61% of previous BZD users reported increased or resumed use after entering methadone program. Compared to the non-users, BZD users were more likely to be White, have prescribed medication for mental problems, have preexistent anxiety problems before opiate use, and had anxiety problems before entering methadone program. They reported more mental health problems in the past month, and had higher scores in anxiety state, depression and perceived stress (p < .05).
CONCLUSIONS
Important information on epidemiology of BZD misuse among methadone-maintenance patients suggests that most methadone programs do not address co-occurring anxiety problems, and methadone treatment may trigger onset or worsening of BZD misuse. Further study is needed to explore how to curb misuse and abuse of BZD in the addiction population, and provide effective treatments targeting simultaneously addiction symptoms, anxiety disorders and BZD misuse.
背景
苯二氮䓬类药物（BZD）滥用是一个严重的公共卫生问题，尤其是在接受美沙酮治疗的阿片类药物依赖伴焦虑症患者中，因为这会使患者面临更高的致命性多药物过量风险。焦虑症升高和 BZD 滥用都会增加前瘾君子复发的风险。然而，目前没有研究评估这个问题的严重程度以及与 BZD 滥用相关的因素。本研究评估了美沙酮治疗计划中 BZD 滥用的流行率，并提供了与非使用者相比 BZD 使用者特征的信息。
方法
在马里兰州巴尔的摩的美沙酮治疗计划中进行了一项匿名调查，通过小组会议和诊所周围的传单邀请所有患者自愿参加。在 205 份返回的问卷中，有 194 份完整并纳入最终数据分析。完成问卷的人将获得一张 5 美元的礼品卡作为感谢。
结果
47%的受访者有 BZD 使用史，39.8%的人未经处方使用 BZD。一半的 BZD 使用者（54%）在进入美沙酮治疗计划后开始使用 BZD，61%的既往 BZD 使用者报告在进入美沙酮治疗计划后增加或恢复使用。与非使用者相比，BZD 使用者更可能是白人，有精神问题的处方药物，在使用阿片类药物之前就有预先存在的焦虑问题，并且在进入美沙酮治疗计划之前就有焦虑问题。他们报告过去一个月有更多的心理健康问题，在焦虑状态、抑郁和感知压力方面的得分更高（p<0.05）。
结论
关于美沙酮维持治疗患者中 BZD 滥用的流行病学的重要信息表明，大多数美沙酮治疗计划都没有解决共病焦虑问题，美沙酮治疗可能会引发或加重 BZD 滥用。需要进一步研究探索如何遏制成瘾人群中 BZD 的滥用和误用，并提供针对同时成瘾症状、焦虑障碍和 BZD 滥用的有效治疗方法。
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