Greer Alissa M, Hu Sherry, Amlani Ashraf, Moreheart Sarah, Sampson Olivia, Buxton Jane A
University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
Subst Abuse Treat Prev Policy. 2016 Jan 14;11:3. doi: 10.1186/s13011-016-0048-3.
In British Columbia, Canada, methadone maintenance treatment formulation transitioned from the oral liquid compound Tang™-flavoured methadone to the ten-times more concentrated cherry-flavoured Methadose™ in February 2014. We quantitatively describe perceptions and reported consequences among a sample of patients on methadone maintenance treatment following this transition.
A province-wide survey was used. Bivariable analyses utilized independent samples t-tests, Phi associations, and Chi-square tests. Multivariable logistic regression analyses evaluated factors related to dependent variables - namely, increases in dose, pain, dope sickness, and the need to supplement with additional opioids.
Four hundred five methadone maintenance treatment patients from fifty harm reduction sites across British Columbia reported transitioning to Methadose™ in February 2014. The majority (n = 258; 73.1 %) heard about the formulation change from their methadone provider or pharmacist. Adjusted models show worse taste was positively associated with reporting an increasing dose (OR = 2.46; CI:1.31-4.61), feeling more dope sick (OR = 3.39; CI:1.88-6.12), and worsening pain (OR = 4.65; CI:2.45-8.80). Feeling more dope sick was positively associated with dose increase (OR = 2.24; CI:1.37-3.66), and supplementing with opioids (OR = 8.81; CI:5.16-15.05).
Methadone maintenance treatment policy changes in British Columbia affect a structurally vulnerable population who may be less able to cope with transitions and loss of autonomy. There may be a psychosocial component contributing to the perception of Methadose™ tasting worse, and increased dope sickness, pain, and dose. Our study shows the pronounced negative impacts medication changes can have on patients without informed, coordinated efforts. We stress the need to engage all stakeholders allowing for communication about the reasons, risks and consequences of medication policy changes and provision of additional psychosocial support.
在加拿大不列颠哥伦比亚省，美沙酮维持治疗配方于2014年2月从口服液体制剂Tang™口味的美沙酮转变为浓度高十倍的樱桃口味的美沙酮（Methadose™）。我们定量描述了此次转变后美沙酮维持治疗患者样本中的认知情况及报告的后果。
采用全省范围的调查。双变量分析使用独立样本t检验、Phi相关性分析和卡方检验。多变量逻辑回归分析评估与因变量相关的因素，即剂量增加、疼痛、戒断反应和补充额外阿片类药物的需求。
来自不列颠哥伦比亚省50个减少伤害场所的405名美沙酮维持治疗患者报告在2014年2月改用了美沙酮（Methadose™）。大多数人（n = 258；73.1%）是从他们的美沙酮提供者或药剂师那里听说配方变化的。调整后的模型显示，味道较差与报告剂量增加（比值比[OR]=2.46；置信区间[CI]：1.31 - 4.61）、感觉戒断反应更强烈（OR = 3.39；CI：1.88 - 6.12）以及疼痛加剧（OR = 4.65；CI：2.45 - 8.80）呈正相关。感觉戒断反应更强烈与剂量增加（OR = 2.24；CI：1.37 - 3.66）以及补充阿片类药物（OR = 8.81；CI：5.16 - 15.05）呈正相关。
不列颠哥伦比亚省美沙酮维持治疗政策的变化影响了一个在结构上易受伤害的人群，他们可能较难应对转变和自主权的丧失。可能存在一个社会心理因素导致对美沙酮（Methadose™）味道更差以及戒断反应、疼痛和剂量增加的认知。我们的研究表明，在没有充分沟通、协调努力的情况下，药物变化可能对患者产生显著的负面影响。我们强调需要让所有利益相关者参与进来，以便就药物政策变化的原因、风险和后果进行沟通，并提供额外的社会心理支持。
