Pilowsky Daniel J, Wu Li-Tzy, Burchett Bruce, Blazer Dan G, Woody George E, Ling Walter
Departments of Epidemiology and Psychiatry, Columbia University, and the New York State Psychiatric Institute, New York City, NY.
Subst Abuse Rehabil. 2011 Jan 1;2:133-144. doi: 10.2147/SAR.S20895.
In response to the rising rate of treatment admissions related to illicit use of amphetamines (eg, methamphetamine), we examined the prevalence of amphetamine use among treatment-seeking, opioid-dependent adults, explored whether amphetamine users were as likely as nonamphetamine users to enroll in opioid-dependence treatment trials, and determined whether amphetamine users manifested greater levels of medical and psychiatric comorbidity than nonusers. METHODS: The sample included 1257 opioid-dependent adults screened for participation in three-multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-003), which studied the effectiveness of buprenorphine for opioid detoxification under varying treatment conditions. Patients were recruited from 23 addiction treatment programs across the US. Medical and psychiatric comorbidity were examined by past-month amphetamine use (current vs former) and route of administration. Five mutually exclusive groups were examined, ie, nonusers, current amphetamine injectors, current amphetamine noninjectors, former amphetamine injectors, and former amphetamine noninjectors. RESULTS: Of the sample (n = 1257), 22.3% had a history of regular amphetamine use. Of the 280 amphetamine users, 30.3% reported injection as their primary route. Amphetamine users were more likely than nonusers to be white and use more substances. Amphetamine users were as likely as non-users to enroll in treatment trials. Bivariate analyses indicated elevated rates of psychiatric problems (depression, anxiety, hallucinations, cognitive impairment, violence, suicidal thoughts/attempts) and medical illnesses (dermatological, hepatic, cardiovascular, respiratory, neurological, seizure, allergy conditions) among amphetamine users. After adjusting for demographic variables and lifetime use of other substances: current amphetamine users and former injectors showed an increased likelihood of having medical illnesses and hospitalizations; current injectors had elevated odds of suicidal thoughts or attempts; current noninjectors exhibited elevated odds of anxiety, cognitive impairment, and violent behaviors; and former noninjectors had increased odds of depression. CONCLUSION: Treatment-seeking, amphetamine-using, opioid-dependent adults manifest greater levels of medical and psychiatric morbidity than treatment-seeking, opioid-dependent adults who have not used amphetamines, indicating a greater need for intensive clinical management.
为应对与苯丙胺（如甲基苯丙胺）非法使用相关的治疗入院率上升的情况，我们调查了寻求治疗的阿片类药物依赖成年人中苯丙胺使用的患病率，探讨了苯丙胺使用者与非苯丙胺使用者参与阿片类药物依赖治疗试验的可能性是否相同，并确定苯丙胺使用者是否比非使用者表现出更高水平的医学和精神疾病共病情况。方法：样本包括1257名阿片类药物依赖成年人，他们被筛选以参与国家药物滥用治疗临床试验网络（CTN001 - 003）的三项多中心研究，这些研究在不同治疗条件下研究丁丙诺啡用于阿片类药物脱毒的有效性。患者从美国23个成瘾治疗项目中招募。通过过去一个月的苯丙胺使用情况（当前使用者与既往使用者）和给药途径来检查医学和精神疾病共病情况。检查了五个相互排斥的组，即非使用者、当前苯丙胺注射者、当前苯丙胺非注射者、既往苯丙胺注射者和既往苯丙胺非注射者。结果：在样本（n = 1257）中，22.3%有规律使用苯丙胺的历史。在280名苯丙胺使用者中，30.3%报告注射为主要给药途径。苯丙胺使用者比非使用者更可能是白人且使用更多物质。苯丙胺使用者与非使用者参与治疗试验的可能性相同。双变量分析表明，苯丙胺使用者中精神问题（抑郁、焦虑、幻觉、认知障碍、暴力、自杀念头/企图）和医学疾病（皮肤病、肝病、心血管病、呼吸道疾病、神经病、癫痫、过敏情况）的发生率升高。在调整人口统计学变量和其他物质的终身使用情况后：当前苯丙胺使用者和既往注射者出现医学疾病和住院的可能性增加；当前注射者有自杀念头或企图的几率升高；当前非注射者出现焦虑、认知障碍和暴力行为的几率升高；既往非注射者患抑郁症的几率增加。结论：寻求治疗的、使用苯丙胺的、阿片类药物依赖成年人比未使用苯丙胺的寻求治疗的阿片类药物依赖成年人表现出更高水平的医学和精神疾病发病率，这表明更需要强化临床管理。
