Levine Amanda R, Lundahl Leslie H, Ledgerwood David M, Lisieski Michael, Rhodes Gary L, Greenwald Mark K
Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, 3901 Chrysler Service Drive, Detroit, MI 48201, USA.
Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, 3901 Chrysler Service Drive, Detroit, MI 48201, USA; Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Detroit, MI 48201, USA.
J Subst Abuse Treat. 2015 Jul;54:37-43. doi: 10.1016/j.jsat.2015.01.009. Epub 2015 Jan 31.
Retention in methadone maintenance treatment (MMT) for 1 year is associated with positive outcomes including opioid abstinence, however, most studies have not investigated gender differences. We hypothesized that predictors of retention and opioid abstinence would differ between men and women, and aimed to determine which factors best predict retention and abstinence for each gender.
Data were available for 290 patients (173 M, 117 F) admitted to outpatient MMT. Regression analyses, stratified by gender, were conducted to identify unique predictors of MMT retention (<1 vs. >1 year) and opioid abstinence rate (proportion of opioid-free urine samples up to 1 year retention).
Gender did not significantly predict treatment retention (mean = 231 days, 39% retained > 1 year) or opioid abstinence (49% overall). For males, significant predictors of > 1-year retention were urine samples negative for opioids (odds ratio [OR] = 6.67) and cannabinoids (OR = 5.00) during the first month, and not cocaine dependent (OR = 2.70). Significant predictors of higher long-term opioid abstinence were first-month urine samples negative for opioids and cocaine metabolites. For females, significant predictors of >1-year retention were first-month urine samples negative for cocaine metabolites (OR = 4.00) and cannabinoids (OR = 9.26), and no history of sexual victimization (OR = 3.03). The only significant predictor of higher opioid abstinence rate was first-month opioid-free urine samples.
These findings indicate gender-specific predictors of MMT retention and opioid abstinence. Future studies on MMT outcomes should examine each gender separately, and consider unique pathways by which females and males adhere to, and benefit from MMT.
美沙酮维持治疗（MMT）一年的留存率与包括阿片类物质戒断在内的积极结果相关，然而，大多数研究尚未调查性别差异。我们假设留存率和阿片类物质戒断的预测因素在男性和女性之间会有所不同，并旨在确定哪些因素能最好地预测每种性别的留存率和戒断情况。
有290名门诊MMT患者（173名男性，117名女性）的数据可用。进行了按性别分层的回归分析，以确定MMT留存（<1年与>1年）和阿片类物质戒断率（留存1年期间无阿片类物质尿液样本的比例）的独特预测因素。
性别并不能显著预测治疗留存率（平均=231天，39%留存超过1年）或阿片类物质戒断率（总体为49%）。对于男性，超过1年留存的显著预测因素是第一个月阿片类物质尿液样本阴性（比值比[OR]=6.67）和大麻素尿液样本阴性（OR=5.00），以及非可卡因依赖（OR=2.70）。长期阿片类物质戒断率较高的显著预测因素是第一个月阿片类物质和可卡因代谢物尿液样本阴性。对于女性，超过1年留存的显著预测因素是第一个月可卡因代谢物尿液样本阴性（OR=4.00）和大麻素尿液样本阴性（OR=9.26），以及无性侵犯史（OR=3.03）。阿片类物质戒断率较高的唯一显著预测因素是第一个月无阿片类物质尿液样本。
这些发现表明了MMT留存率和阿片类物质戒断的性别特异性预测因素。未来关于MMT结果的研究应分别检查每种性别，并考虑男性和女性坚持MMT并从中受益的独特途径。
