美沙酮维持治疗方案中获得“带出院”权限和长期结局
Earning "take-home" privileges and long-term outcome in a methadone maintenance treatment program.
机构信息
Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
出版信息
J Addict Med. 2011 Jun;5(2):92-8. doi: 10.1097/ADM.0b013e3181e6ad48.
OBJECTIVES
This observational prospective study aimed to determine whether duration to the earning of privileges of "take-home" methadone doses (as a part of behavioral enforcement) reflects long-term outcome of patients in methadone maintenance treatment (MMT).
METHODS
All 657 former heroin addicts admitted to our MMT clinic between June 1993 and June 2008 were prospectively studied and followed up. Duration from admission to first take-home dose (until October 2008), to leaving (retention, until June 2009), and to dying (survival, until June 2008) was calculated.
RESULTS
Most patients (n = 435; 66.2%) ever achieved take-home privileges. Retention was longest (10 years, 95% confidence interval [CI]: 8.8 to 11.2) for 110 patients who achieved their first take-home dose after 3 to 6 months, followed by 9 years (95% CI: 7.7 to 10.3) for 98 patients who achieved it after >6 months and ≤1 year, and 8.3 years (95% CI: 7.2 to 9.4) for 127 patients who managed to achieve it only after >1 year. Retention was lower among patients who were given exceptional take-home doses (not respecting policy regulations) <3 months since admission: 5.1 years (95% CI: 3.4 to 7.8) for 30 patients (who got it for medical reasons), 9 years (95% CI: 6.7 to 11.3) for 14 patients admitted from another MMT, and 6.3 years (95% CI: 5 to 7.6) for 56 patients who got it for unjustified (mistakes) reasons. The shortest retention in MMT was 2.2 years (95% CI: 1.8 to 2.7, P < 0.0005) for 222 patients who never managed to achieve any take-home privileges. Survival was longer among patients who ever versus never received take-home privileges (13.2 years [95% CI: 12.8 to 13.6] vs 12.3 years [95% CI: 11.5 to 13.1], respectively; P = 0.04) and longest (14.1 years [95% CI: 13.4 to 14.7]) among those who received take-home privileges after 3 to 6 months.
CONCLUSIONS
The group with the shortest time (3 to 6 months) to the achievement of first take-home dose had the best outcome. Further studies are needed to characterize this group.
目的
本观察性前瞻性研究旨在确定获得“带出院”美沙酮剂量（作为行为强化的一部分）的特权的时间长短是否反映了美沙酮维持治疗（MMT）患者的长期结局。
方法
1993 年 6 月至 2008 年 6 月期间，我们的 MMT 诊所共收治了 657 名前海洛因成瘾者，对他们进行了前瞻性研究和随访。计算从入院到首次带出院剂量（截至 2008 年 10 月）、离开（保留，截至 2009 年 6 月）和死亡（生存，截至 2008 年 6 月）的时间。
结果
大多数患者（n=435；66.2%）曾获得带出院特权。对于 110 名在 3 至 6 个月后首次获得带出院剂量的患者，保留时间最长（10 年，95%置信区间[CI]：8.8 至 11.2），对于 98 名在 6 个月至 1 年内获得带出院剂量的患者，保留时间为 9 年（95%CI：7.7 至 10.3），对于 127 名在 1 年以上才能获得带出院剂量的患者，保留时间为 8.3 年（95%CI：7.2 至 9.4）。对于在入院后 <3 个月内获得特殊带出院剂量（不遵守政策规定）的患者，保留时间较短：30 名因医疗原因获得带出院剂量的患者为 5.1 年（95%CI：3.4 至 7.8），14 名从其他 MMT 转入的患者为 9 年（95%CI：6.7 至 11.3），56 名因无正当理由（错误）获得带出院剂量的患者为 6.3 年（95%CI：5 至 7.6）。在从未获得任何带出院特权的 222 名患者中，MMT 的保留时间最短为 2.2 年（95%CI：1.8 至 2.7，P<0.0005）。
结论
与从未获得带出院特权的患者相比，曾获得带出院特权的患者生存时间更长（13.2 年[95%CI：12.8 至 13.6]与 12.3 年[95%CI：11.5 至 13.1]，P=0.04），获得带出院特权后 3 至 6 个月的患者生存时间最长（14.1 年[95%CI：13.4 至 14.7]）。需要进一步的研究来描述这个群体。
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