1)Neurocognitive Laboratory, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran. 4)Translational Neuroscience Program, Institute for Cognitive Sciences Studies, Tehran,
Arch Iran Med. 2013 Oct;16(10):599-601.
Methadone detoxification is among the widely used treatment programs for opioid dependence. The aims of this study were to identify which patient baseline factors and treatment regimen features are predictors of the treatment outcome in an outpatient flexible dose-duration methadone detoxification program. We studied 126 opioid dependents in a naturalistic nonexperimental clinical setting. The patients were assessed for baseline demographic characteristics, and drug abuse characteristics. Treatment regimen features were recorded during the program. Successful treatment completion was defined as the last daily dose of methadone being less than 15 mg, negative urine analysis in the last two weeks of treatment, and based on the final clinician-client's decision. Out of 126 patients, 60 patients completed detoxification successfully. Younger age, longer duration of the opioid abuse, and higher subjective opiate intoxication severity before treatment entry were all significantly associated with negative treatment outcome. Among treatment regimen features, higher maximum methadone dose had a marginally significant independent effect on treatment failure. Patients with maximum methadone dose of more than 75 mg per day had around ten times worse success rate when compared to those who received lesser doses. The study findings could be used to predict treatment outcome and prognosis in a more individualized and patient-tailored approach in the real clinical setting. Guideline development for treatment selection and outcome monitoring in addiction medicine based on similar studies could enhance treatment outcome in clinical services.
美沙酮脱毒治疗是广泛应用于阿片类药物依赖治疗的方案之一。本研究旨在确定门诊灵活剂量-时间美沙酮脱毒方案中哪些患者基线因素和治疗方案特征是治疗结果的预测因素。我们在自然的非实验临床环境中研究了 126 名阿片类药物依赖者。对患者进行基线人口统计学特征和药物滥用特征评估。在治疗过程中记录治疗方案特征。成功完成治疗定义为最后一天的美沙酮剂量小于 15mg，治疗最后两周的尿液分析呈阴性，并且基于最终临床医生和患者的决定。在 126 名患者中，60 名成功完成了脱毒治疗。年龄较小、阿片类药物滥用时间较长以及治疗前主观阿片类药物中毒严重程度较高，与不良治疗结果显著相关。在治疗方案特征中，美沙酮最大剂量越高，治疗失败的独立影响越显著。与接受较小剂量美沙酮的患者相比，每日最大剂量超过 75mg 的患者的成功率要低十倍左右。这些研究结果可用于在真实临床环境中更个体化和针对患者的方法预测治疗结果和预后。基于类似研究的成瘾医学治疗选择和结果监测指南的制定，可以提高临床服务中的治疗效果。
