Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences (CHEOS), Department of Psychiatry, Faculty of Medicine, University of British Columbia, Canada.
University of Basel, Department of Psychiatry (UPK), Division of Addictive Disorders, Switzerland.
Int J Drug Policy. 2018 Jul;57:18-24. doi: 10.1016/j.drugpo.2018.03.021. Epub 2018 Apr 12.
Employment is one of the less studied but a significant outcome of medication-assisted treatment. Thus, we aimed to explore employment outcomes of medication-assisted treatment with hydromorphone (HDM) or diacetylmorphine (DAM). The secondary aim was to estimate characteristics of this population as well as treatment-related factors associated with these outcomes.
This was a secondary analysis of a randomized, double blind controlled trial. A total of 102 and 100 participants were randomized to receive injectable DAM or HDM for 6 months respectively. In stage 2, 144 participants were randomized again to receive either oral or injectable forms of the medication they received for another 6 months. Participants were interviewed at 5 timepoints: before and 3, 6, 9 and 12 months after treatment assignment. Generalized estimating equations (GEE) with a logit link was fitted to determine factors related to paid work in the past 30 days.
Mean age of participants was 44.3 (SD = 9.6) and 59 (29.2%) participants were men. At each timepoint, 6-8 (3.6%-4.1%) participants reported employment in the past 30 days and 40 to 52 (19.7%-26.7%) reported minimum 1 day of paid work. University or college education [OR = 2.12: 95% CI = (1.25, 3.62), P = 0.01] was significantly associated with paid work after adjustment for age, gender, treatment arms, timepoints, days receiving study treatment, physical health, psychological health and crack cocaine use in the past 30 days.
The rate of employment was lower among participants of this study compared to similar studies on heroin-assisted treatment. Higher education was associated with increased odds of paid work. A large gap exists between employment rate and the proportion of participants who reported paid work. Supported employment and occupational therapy could optimize the employment outcomes of this population.
就业是药物辅助治疗中研究较少但意义重大的结果之一。因此，我们旨在探讨氢可酮（HDM）或二乙酰吗啡（DAM）药物辅助治疗的就业结果。次要目的是评估该人群的特征以及与这些结果相关的治疗相关因素。
这是一项随机、双盲对照试验的二次分析。共有 102 名和 100 名参与者分别被随机分配接受 6 个月的注射用 DAM 或 HDM 治疗。在第 2 阶段，又有 144 名参与者被随机再次接受他们接受的药物的口服或注射形式治疗 6 个月。参与者在治疗分配前和治疗后 3、6、9 和 12 个月接受了 5 次访谈。使用对数链接的广义估计方程（GEE）拟合确定与过去 30 天内有薪工作相关的因素。
参与者的平均年龄为 44.3（SD=9.6），59 名（29.2%）参与者为男性。在每个时间点，有 6-8 名（3.6%-4.1%）参与者报告过去 30 天内有薪工作，有 40-52 名（19.7%-26.7%）参与者报告至少有 1 天有薪工作。在调整年龄、性别、治疗手臂、时间点、接受研究治疗的天数、身体健康、心理健康和过去 30 天内使用快克可卡因后，大学或学院教育[OR=2.12：95%CI=（1.25，3.62），P=0.01]与有薪工作显著相关。
与类似的海洛因辅助治疗研究相比，这项研究的参与者的就业率较低。高等教育与有偿工作的几率增加相关。就业比率和报告有薪工作的参与者比例之间存在很大差距。支持性就业和职业治疗可以优化该人群的就业结果。
