Lister Jamey J, Greenwald Mark K, Ledgerwood David M
Substance Abuse Research Division, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA; School of Social Work, Wayne State University, Detroit, MI, USA.
Substance Abuse Research Division, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA; Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.
J Subst Abuse Treat. 2017 Jul;78:15-21. doi: 10.1016/j.jsat.2017.04.007. Epub 2017 Apr 14.
Drug use during methadone induction/stabilization negatively influences later methadone-maintenance-treatment [MMT] outcomes (retention, abstinence). Our study examined the association of baseline risk factors to drug use during the first month of methadone treatment as well as longer-term treatment retention. We conducted these analyses among a race/ethnic minority group at high risk for worse MMT outcomes. African-American MMT patients (N=212) were interviewed at intake to assess clinical (drug use history), psychosocial (close family member substance abuse, psychosocial problems), and demographic factors. Outcomes were first-month opioid and cocaine urine drug screen [UDS] results and retention (days in treatment). In bivariate analyses, co-occurring cocaine abuse/dependence was associated with worse outcomes for opioid UDS, cocaine UDS, and retention. Being a primary injection opioid user and residing farther from the clinic were associated with a higher proportion of cocaine UDS and shorter retention, respectively. Patients with a significant other substance abuse history provided a higher proportion of both opioid and cocaine UDS. Sibling and parent substance abuse histories were associated with a higher proportion of opioid UDS and shorter retention. Psychosocial problems (economic, housing) were associated with a higher proportion of cocaine UDS. In multivariate analyses, co-occurring cocaine abuse/dependence and primary injection opioid use best accounted for first-month opioid and cocaine UDS, respectively. A higher proportion of first-month opioid and cocaine UDS and living farther from the clinic accounted for retention. African-American patients reporting baseline risk factors (particularly clinical) experience worse short- and long-term MMT outcomes. Recommendations for improving standards of care are discussed.
在美沙酮诱导/稳定治疗期间使用毒品会对后期美沙酮维持治疗（MMT）的结果（留存率、戒断情况）产生负面影响。我们的研究考察了基线风险因素与美沙酮治疗第一个月期间的毒品使用以及长期治疗留存率之间的关联。我们在一个MMT结果较差风险较高的种族/族裔少数群体中进行了这些分析。对非裔美国MMT患者（N = 212）在入组时进行访谈，以评估临床因素（吸毒史）、心理社会因素（亲密家庭成员药物滥用、心理社会问题）和人口统计学因素。结果指标为第一个月的阿片类药物和可卡因尿液药物筛查（UDS）结果以及留存率（治疗天数）。在双变量分析中，同时存在的可卡因滥用/依赖与阿片类药物UDS、可卡因UDS以及留存率的较差结果相关。作为主要的注射阿片类药物使用者以及居住距离诊所较远分别与更高比例的可卡因UDS和更短的留存率相关。有重要他人药物滥用史的患者提供了更高比例的阿片类药物和可卡因UDS。兄弟姐妹和父母的药物滥用史与更高比例的阿片类药物UDS以及更短的留存率相关。心理社会问题（经济、住房）与更高比例的可卡因UDS相关。在多变量分析中，同时存在的可卡因滥用/依赖和主要的注射阿片类药物使用分别最能解释第一个月的阿片类药物和可卡因UDS情况。更高比例的第一个月阿片类药物和可卡因UDS以及居住距离诊所较远可解释留存率情况。报告有基线风险因素（尤其是临床因素）的非裔美国患者在短期和长期MMT结果方面较差。文中讨论了改善护理标准的建议。
