Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300-8888 University Dr., Burnaby, British Columbia, V5A 1S6, Canada.
Int J Drug Policy. 2018 Jun;56:73-80. doi: 10.1016/j.drugpo.2018.03.012. Epub 2018 Mar 31.
Opioid overdose deaths have become a public health crisis in North America, and those who are homeless are particularly vulnerable. Methadone maintenance treatment (MMT) may prevent overdose and death among homeless people with opioid dependence, but suboptimal medication adherence is a common limitation. Previous research found that Housing First (HF) increases antipsychotic medication adherence among formerly homeless people. However, no experimental trials have examined whether HF has a significant impact on MMT adherence. We examined the intervention effect of HF on MMT adherence in a randomized sample of homeless adults experiencing mental illness and opioid dependence in Vancouver, Canada.
Comprehensive administrative and self-reported data from homeless adults living with serious mental illness recruited to the Vancouver At Home study were analyzed. Only methadone recipients were included (n = 97). The medication possession ratio (MPR) was utilized as the measure of adherence, and relevant data were obtained from provincial administrative pharmacy records. Study arms were HF and treatment as usual (TAU). Student t-tests were used to test for differences in MMT MPR between HF and TAU.
No significant differences were observed in MMT MPR between participants in HF and TAU (0.52 vs. 0.57, p = 0.559) in the post-randomization period.
HF was not associated with significantly different MMT MPR compared to TAU. Additional interventions are indicated as HF alone was insufficient to facilitate improved MMT adherence among formerly homeless adults experiencing concurrent opioid dependence and serious mental illness.
阿片类药物过量死亡已成为北美的公共卫生危机，而无家可归者尤其脆弱。美沙酮维持治疗（MMT）可能预防有阿片类药物依赖的无家可归者发生过量和死亡，但药物依从性差是一个常见的局限性。先前的研究发现，“先住后附条件”（HF）增加了以前无家可归的精神疾病和阿片类药物依赖者对抗精神病药物的依从性。然而，尚无实验性试验研究 HF 是否对 MMT 依从性有显著影响。我们在加拿大温哥华的一项针对经历精神疾病和阿片类药物依赖的无家可归成年人的随机抽样中，研究了 HF 对 MMT 依从性的干预效果。
对参加温哥华住家研究的患有严重精神疾病的无家可归成年人进行了全面的行政和自我报告数据分析。仅包括接受美沙酮治疗的成年人（n=97）。药物使用量比值（MPR）被用作依从性的衡量标准，相关数据从省级行政药房记录中获得。研究组为 HF 和常规治疗（TAU）。使用学生 t 检验比较 HF 和 TAU 之间 MMT MPR 的差异。
在随机分组后的随访期间，HF 组和 TAU 组的 MMT MPR 没有显著差异（0.52 与 0.57，p=0.559）。
与 TAU 相比，HF 与 MMT MPR 无显著差异。需要额外的干预措施，因为 HF 单独使用不足以促进同时患有阿片类药物依赖和严重精神疾病的前无家可归成年人改善 MMT 依从性。
