Bobes García Julio, Bobes Bascarán María Teresa
Adicciones. 2012;24(3):179-83.
There is no large prospective cohort studies using different therapeutic doses and standardized distal outcomes, however there is a fair amount of evidence on the effectiveness of methadone as a long-term treatment for the addiction to opiates. Strengths include less illegal drug use, decreased criminal activity and better general functioning. Also physical and mental health seems to be more preserved and recovered. Since patients undergoing methadone treatment exhibit diminished likelihood of suffering from cardiovascular conditions, HIV, HCV, HBV and other infections, and lesser psychiatric comorbidity. This Editorial intends to define and guide the therapeutic statement to address the management of persons with opiate abuse or dependence. These proposals have been grounded in the main long-term studies, systematic analysis and meta-analytic approaches on the effectiveness of methadone. Thereby it is recommended, with the maximum level of evidence, methadone maintenance treatments in spite of its weaknesses (ie. Toxicity, cardiovascular risk, sedation problems and cognitive impairment), considering the clinical history, general health status, and willingness and preferences of the patient.
目前尚无使用不同治疗剂量和标准化远期结局的大型前瞻性队列研究，然而，有相当多的证据表明美沙酮作为阿片类药物成瘾的长期治疗方法是有效的。其优势包括减少非法药物使用、降低犯罪活动以及改善整体功能。此外，身心健康似乎得到了更好的维护和恢复。因为接受美沙酮治疗的患者患心血管疾病、艾滋病毒、丙型肝炎病毒、乙型肝炎病毒和其他感染的可能性降低，且精神疾病合并症较少。本社论旨在界定并指导治疗声明，以解决阿片类药物滥用或依赖者的管理问题。这些提议基于关于美沙酮有效性的主要长期研究、系统分析和荟萃分析方法。因此，尽管美沙酮存在一些缺点（即毒性、心血管风险、镇静问题和认知障碍），但考虑到患者的临床病史、总体健康状况以及意愿和偏好，仍以最高证据水平推荐美沙酮维持治疗。
