King's College London, Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom; Alcohol, Drugs, Tobacco and Justice Division, Health Improvement Directorate, Public Health England, 7th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, United Kingdom.
King's College London, Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom.
Drug Alcohol Depend. 2018 Jul 1;188:200-208. doi: 10.1016/j.drugalcdep.2018.03.052. Epub 2018 May 16.
This is the first national study in England of continuous long-term opioid substitution treatment (OST).
All adults were admitted to community OST for opioid use disorder (OUD) in 2008/09 with continuous enrolment to 2013/14 (n = 7719). Heroin use trajectories were identified by multilevel Latent Class Growth Analysis. In Year 6 and 7 of follow-up, the outcome measure (analysed by multilevel, multivariable logistic regression) was 'successful completion and no re-presentation' (SCNR) to community treatment within six months.
Five heroin use trajectory classes were identified: 'gradual decreasing' (20.9%), 'decreasing then increasing' (21.7%), 'continued low-level' (17.0%), 'rapid decreasing' (25.6%), and 'continued high-level' (14.8%). At the end of Year 7, 4616 people (60.3%) remained in OST. Of those discharged, 28.8% achieved the SCNR follow-up outcome. SCNR was more likely in the 'gradual decreasing' (adjusted odds ratio [AOR] 2.40; 95% confidence interval [CI] 1.77-3.26), 'continued low-level' (AOR 2.46; CI 1.78-3.40), and 'rapid decreasing' (AOR 3.40; CI 2.43-4.37) classes relative to the 'continued high-level' class. SCNR was more likely among patients employed at admission (AOR 1.45; 95% CI 1.15-1.83) and those receiving adjunctive psychosocial interventions (AOR 1.44; 95% CI 1.03 to 2.02).
Among English patients in OST for 5 years, heroin use trajectories were clearly delineated with a gradient of response on the study outcome. Successful completion and no re-presentation was achieved by 28.8% of discharged patients. The rapid decreasing trajectory had the greatest likelihood of positive outcome. Adjunctive psychosocial intervention during OST was associated with positive outcome.
这是在英格兰进行的首次关于持续长期阿片类物质替代治疗（OST）的全国性研究。
2008/09 年，所有成年人因阿片类物质使用障碍（OUD）接受社区 OST，连续登记至 2013/14 年（n=7719）。采用多层次潜在类别增长分析确定海洛因使用轨迹。在第 6 年和第 7 年的随访中，结局测量（采用多层次、多变量逻辑回归分析）为在 6 个月内“成功完成且无再次就诊”（SCNR）至社区治疗。
确定了 5 种海洛因使用轨迹类别：“逐渐减少”（20.9%）、“减少后增加”（21.7%）、“持续低水平”（17.0%）、“快速减少”（25.6%）和“持续高水平”（14.8%）。在第 7 年末，4616 人（60.3%）仍在 OST 中。在出院者中，28.8%达到 SCNR 随访结局。与“持续高水平”类别相比，“逐渐减少”（调整后的优势比[OR]2.40；95%置信区间[CI]1.77-3.26）、“持续低水平”（OR 2.46；CI 1.78-3.40）和“快速减少”（OR 3.40；CI 2.43-4.37）类别更有可能达到 SCNR。在入院时就业的患者（OR 1.45；95%CI 1.15-1.83）和接受辅助心理社会干预的患者（OR 1.44；95%CI 1.03-2.02）中，SCNR 更有可能发生。
在接受 OST 治疗 5 年的英国患者中，海洛因使用轨迹明显不同，研究结局存在差异。在出院患者中，有 28.8%达到了成功完成且无再次就诊的目标。快速减少轨迹具有最大的积极结果可能性。OST 期间辅助心理社会干预与积极结果相关。
