Marienfeld Carla, Liu Pulin, Wang Xia, Schottenfeld Richard, Zhou Wang, Chawarski Marek C
Yale School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
Wuhan Centers for Disease Prevention and Control, 24 Jianghan North Road, Wuhan, PR China; Tongji Medical College, School of Public Health, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan, PR China.
Drug Alcohol Depend. 2015 Dec 1;157:60-7. doi: 10.1016/j.drugalcdep.2015.10.001. Epub 2015 Oct 8.
Methadone maintenance treatment (MMT) reduces the harms of opioid use disorder and is being rapidly scaled-up in China. This study evaluated the real-world implementation of MMT system in Wuhan, China.
Data extracted from electronic medical records collected in 2010 on 8811 patients were used to compute for each patient indices of the prescribed and consumed daily methadone doses, an adherence index, dose adjustments following missed doses, the rates of opiate positive urine tests, self-reported drug use, injection drug use (IDU), and the duration of MMT exposure.
The modal daily doses prescribed were 60 mg and above for 68.5% of patients. Adherence was variable: 51% of patients attended less than 60% and 26% attended 80-100% of their treatment days; and patients with long MMT exposure had significantly higher adherence rates than patients with short MMT exposure. The differences between doses dispensed immediately before and after the interruption in dosing days ranged from 0 to 7 mg, independently of the length of the interruption or the prescribed dosing level. The overall rate of opiate positive tests was 20%; 45% of patients had at least one opiate positive test; 29% reported past month drug use and 53% of them reported past month IDU. Adherence and MMT exposure duration correlated significantly with the proportion of opiate negative urine tests (r=0.355, p<0.001; r=0.351, p<0.001, respectively). Treatment for males and females was comparable.
Provision of safe methadone dosing after absences and improving daily attendance are identified as priority improvement areas.
美沙酮维持治疗（MMT）可减少阿片类物质使用障碍的危害，且在中国正迅速推广。本研究评估了中国武汉MMT系统的实际实施情况。
从2010年收集的8811例患者的电子病历中提取数据，计算每名患者的美沙酮每日处方剂量和服用剂量指标、依从性指标、漏服后的剂量调整、阿片类物质尿检阳性率、自我报告的药物使用情况、注射吸毒（IDU）情况以及MMT暴露持续时间。
68.5%的患者每日处方剂量为60毫克及以上。依从性各不相同：51%的患者治疗天数的就诊率低于60%，26%的患者就诊率为80%-100%；MMT暴露时间长的患者依从率显著高于MMT暴露时间短的患者。给药天数中断前后立即发放的剂量差异为0至7毫克，与中断时间长短或规定的给药水平无关。阿片类物质尿检阳性总率为20%；45%的患者至少有一次阿片类物质尿检阳性；29%的患者报告过去一个月使用过药物，其中53%报告过去一个月有注射吸毒行为。依从性和MMT暴露持续时间与阿片类物质尿检阴性比例显著相关（分别为r=0.355，p<0.001；r=0.351，p<0.001）。男性和女性的治疗情况相当。
确定在漏服后提供安全的美沙酮剂量以及提高每日就诊率为优先改进领域。
