Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States.
Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States.
Drug Alcohol Depend. 2018 Jun 1;187:343-350. doi: 10.1016/j.drugalcdep.2018.03.009. Epub 2018 Apr 16.
This randomized clinical trial evaluated the efficacy of three treatment initiation strategies for improving retention to methadone maintenance for opioid-dependent individuals referred from a syringe exchange program (SEP). New admissions (n = 212) were randomly assigned to one of three 3-month initiation strategies: 1) Low Threshold (LTI), 2) Voucher Reinforcement (VRI), or 3) Standard Care (SCI). LTI was modeled on interim methadone maintenance to transition SEP admissions to the structure of medication-assisted treatment while maximizing exposure to methadone pharmacotherapy. VRI used monetary incentives to reinforce adherence to pharmacotherapy and adaptive counseling. SCI participants received standard methadone dosing and adaptive counseling. All participants were stabilized on methadone pharmacotherapy with a target dose of 80 mg. Following the initiation phase, participants in each condition received standard adaptive counseling from months 4-6. Results showed that most participants failed to achieve the target methadone dose. While no condition differences were observed in retention rates over the 3-month and 6-month observation periods, participants across conditions exhibited reductions in objective and self-report measures of drug use. Results support the benefits of referring syringe exchangers to methadone maintenance, and demonstrate the challenge of retaining these individuals in treatment.
这项随机临床试验评估了三种治疗起始策略对改善从注射器交换计划（SEP）转介的阿片类药物依赖者接受美沙酮维持治疗的保留率的疗效。新入院患者（n=212）被随机分配到以下三种为期 3 个月的起始策略之一：1）低门槛（LTI）、2）凭证强化（VRI）或 3）标准护理（SCI）。LTI 是基于中途美沙酮维持治疗来转变 SEP 入院者接受药物辅助治疗的结构，同时最大限度地增加美沙酮药物治疗的暴露率。VRI 使用金钱奖励来强化对药物治疗和适应性咨询的依从性。SCI 参与者接受标准美沙酮剂量和适应性咨询。所有参与者都接受美沙酮药物治疗，目标剂量为 80mg。在起始阶段之后，每个条件的参与者在第 4-6 个月接受标准适应性咨询。结果表明，大多数参与者未能达到目标美沙酮剂量。虽然在 3 个月和 6 个月的观察期内，在保留率方面没有观察到条件差异，但所有条件的参与者都表现出客观和自我报告的药物使用减少。结果支持将注射器交换者转介至美沙酮维持治疗的益处，并表明在治疗中留住这些人的挑战。
