Bach Paxton, Milloy M-J, Nguyen Paul, Koehn John, Guillemi Silvia, Kerr Thomas, Wood Evan
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
Department of Medicine, University of British Columbia, Vancouver, Canada.
Drug Alcohol Rev. 2015 Sep;34(5):503-507. doi: 10.1111/dar.12251. Epub 2015 Mar 4.
Methadone maintenance therapy (MMT) is an evidence-based treatment for opioid addiction. While gender differences in MMT pharmacokinetics, drug use patterns and clinical profiles have been previously described, few studies have compared rates of MMT use among community-recruited samples of persons who inject drugs (PWID).
The present study used prospective cohorts of PWID followed between May 1996 and May 2013 in Vancouver, British Columbia, Canada. We investigated potential factors associated with time to methadone initiation using Cox proportional hazards modelling. Stratified analyses were used to examine for gender differences in rates of MMT enrolment.
Overall, 1848 baseline methadone-naïve PWID were included in the study, among whom 595 (32%) were female. In an adjusted model, male gender was independently associated with increased time to MMT initiation and an overall lower rate of enrolment [adjusted relative hazard = 0.74 (95% confidence interval: 0.65-0.85)]. Among both female and male PWID, Caucasian ethnicity and daily injection heroin use were associated with decreased time to methadone initiation, while in females, pregnancy was also associated with more rapid initiation.
These data highlight gender differences in methadone use among a population of community-recruited PWID. While factors associated with methadone use were similar between genders, rates of use were lower among male PWID, highlighting the need to consider gender when designing strategies to improve recruitment into MMT. [Bach P, Milloy M-J, Nguyen P, Koehn J, Guillemi S, Kerr T, Wood E. Gender differences in access to methadone maintenance therapy in a Canadian setting. Drug Alcohol Rev 2015;34:503-7].
美沙酮维持治疗（MMT）是一种基于证据的阿片类药物成瘾治疗方法。虽然此前已有关于MMT药代动力学、药物使用模式和临床特征方面的性别差异描述，但很少有研究比较社区招募的注射吸毒者（PWID）样本中MMT的使用比例。
本研究采用了1996年5月至2013年5月在加拿大不列颠哥伦比亚省温哥华市对PWID进行随访的前瞻性队列研究。我们使用Cox比例风险模型研究了与开始使用美沙酮时间相关的潜在因素。采用分层分析来检验MMT登记比例中的性别差异。
总体而言，1848名基线时未使用美沙酮的PWID纳入了本研究，其中595名（32%）为女性。在一个校正模型中，男性与开始MMT的时间增加以及总体较低的登记比例独立相关[校正相对风险=0.74（95%置信区间：0.65 - 0.85）]。在女性和男性PWID中，白种人种族和每日注射海洛因与开始使用美沙酮的时间缩短相关，而在女性中，怀孕也与更快开始使用相关。
这些数据突出了社区招募的PWID人群中美沙酮使用的性别差异。虽然与美沙酮使用相关的因素在性别间相似，但男性PWID的使用比例较低，这凸显了在设计改善MMT招募策略时考虑性别的必要性。[巴赫P，米洛伊M - J，阮P，克恩J，吉列米S，克尔T，伍德E。加拿大环境下美沙酮维持治疗获取方面的性别差异。《药物与酒精评论》2015；34：503 - 7]
