Oviedo-Joekes Eugenia, Guh Daphne, Marchand Kirsten, Marsh David C, Lock Kurt, Brissette Suzanne, Anis Aslam H, Schechter Martin T
Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St, Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada.
Subst Abuse Treat Prev Policy. 2014 Jun 8;9:23. doi: 10.1186/1747-597X-9-23.
The most widely used maintenance treatment for opioid dependency is substitution with long-acting oral opioids. Treatment with injectable diacetylmorphine provides an opportunity for patients to stabilize and possibly transition to oral treatment, if clinically indicated. The aim of this study was to explore outcomes of individuals that received injectable diacetylmorphine and voluntarily transitioned to oral methadone.
The North American Opiate Medication Initiative was a randomized controlled trial that compared the effectiveness of injectable diacetylmorphine (or hydromorphone) to oral methadone for long-term opioid-dependency. Treatment was provided for 12-months with an additional 3 months for transition and weaning. Participants were followed until 24-months from randomization. Among the participants randomized to injectable treatments, a sub-group voluntarily chose to transition to oral methadone (n = 16) during the treatment period. Illicit heroin use and treatment retention were assessed at 24-months for those voluntarily and involuntarily transitioning (n = 95) to oral methadone.
At 24-months, the group that voluntarily transitioned to oral methadone had higher odds of treatment retention (adjusted odds ratio = 5.55; 95% confidence interval [CI] = 1.11, 27.81; Chi-square = 4.33, df = 1, p-value = 0.037) than the involuntary transition group. At 24-months, the adjusted mean difference in prior 30 days of illicit heroin use for the voluntary, compared to the involuntary group was -5.58 (95% CI = -11.62, 0.47; t-value = -1.83, df = 97.4, p-value = 0.070).
Although the results of this study were based on small groups of self-selected (i.e., non-randomized) participants, our data underlines the critical importance of voluntary and patient-centered decision making. If we had continued offering treatment with diacetylmorphine, those retained to injectable medication may have sustained the achieved improvements in the first 12 months. Diversified opioid treatment should be available so patients and physicians can flexibly choose the best treatment at the time.
NCT00175357.
阿片类药物依赖最广泛使用的维持治疗方法是用长效口服阿片类药物进行替代。如果临床有指征，注射用二乙酰吗啡治疗为患者提供了稳定病情并可能过渡到口服治疗的机会。本研究的目的是探讨接受注射用二乙酰吗啡并自愿过渡到口服美沙酮的个体的治疗结果。
北美阿片类药物治疗计划是一项随机对照试验，比较了注射用二乙酰吗啡（或氢吗啡酮）与口服美沙酮治疗长期阿片类药物依赖的有效性。治疗为期12个月，另有3个月用于过渡和戒断。对参与者随访至随机分组后24个月。在随机分配接受注射治疗的参与者中，一个亚组在治疗期间自愿选择过渡到口服美沙酮（n = 16）。对自愿和非自愿过渡到口服美沙酮的参与者（n = 95）在24个月时评估非法海洛因使用情况和治疗保留率。
在24个月时，自愿过渡到口服美沙酮的组比非自愿过渡组有更高的治疗保留几率（调整后的优势比 = 5.55；95%置信区间[CI] = 1.11, 27.81；卡方 = 4.33，自由度 = 1，p值 = 0.037）。在24个月时，与非自愿组相比，自愿组在过去30天内非法海洛因使用的调整后平均差异为 -5.58（95% CI = -11.62, 0.47；t值 = -1.83，自由度 = 97.4，p值 = 0.070）。
尽管本研究结果基于一小群自我选择（即非随机）的参与者，但我们的数据强调了自愿和以患者为中心的决策的至关重要性。如果我们继续提供二乙酰吗啡治疗，那些继续接受注射用药物治疗的人可能会维持在最初12个月所取得的改善。应提供多样化的阿片类药物治疗，以便患者和医生能够在当时灵活选择最佳治疗方法。
NCT00175357。
