一刀切并不适用——23 年来自然环境下阿片类激动剂治疗的演变。

One size does not fit all-evolution of opioid agonist treatments in a naturalistic setting over 23 years.

机构信息

Department for Psychiatry, Psychotherapy and Psychosomatics, Centre for Addictive Disorders, University Hospital of Psychiatry Zurich, Zurich, Switzerland.

Division of Addictive Disorders, University of Basel Psychiatric Hospital, Basel, Switzerland.

出版信息

Addiction. 2019 Jan;114(1):103-111. doi: 10.1111/add.14442. Epub 2018 Oct 15.

DOI:10.1111/add.14442

PMID:30209840

Abstract

BACKGROUND AND AIMS

Opioid agonist treatment (OAT) is currently the most effective treatment for people with opioid dependence. In most countries, however, access to the whole range of effective medications is restricted. This study aims to model the distribution of different OAT medications within a naturalistic and relatively unrestricted treatment setting (Zurich, Switzerland) over time, and to identify patient characteristics associated with each medication.

METHODS

We used generalized estimating equation analysis with data from the OAT register of Zurich and the Swiss register for heroin-assisted treatment (HAT) to model and forecast the annual proportion of opioids applying exponential distributions until 2018 and patient characteristics between 1992 and 2015.

RESULTS

Data from 11 895 patients were included in the analysis. Methadone remains the mainstay of OAT, being prescribed to two-thirds of patients. Following its approval, the proportion of HAT increased rapidly and is now constant at 12.16% [95% confidence interval (CI) = 11.15-13.17]. The initial increase of proportions of buprenorphine or slow-release oral morphine (SROM) following their approval for OAT was slower. While in 2014 both medications had a proportion of 10.2% and 10.3%, respectively, our model predicts a further increase of SROM to 19.9% in 2018, with a ceiling level of 25.19% (21.40-28.98%) thereafter. SROM patients display characteristics similar to those treated with methadone; buprenorphine patients show the highest social integration; and HAT patients are the most homogeneous group, with highest mean age, most widespread injecting experience and lowest social integration.

CONCLUSIONS

Based on data from Zurich, Switzerland from 1992 to 2015, there is no evidence for an excessive demand for a single medication in a naturalistic and liberal opioid agonist treatment setting. Rather, the specific patient characteristics associated with each medication underline the need for diversified treatment options for opioid dependence.

摘要

背景与目的

阿片类激动剂治疗（OAT）是目前治疗阿片类药物依赖最有效的方法。然而，在大多数国家，有效的药物治疗范围受到限制。本研究旨在对在自然且相对不受限制的治疗环境（瑞士苏黎世）中，不同 OAT 药物的分布情况进行建模，并确定与每种药物相关的患者特征。

方法

我们使用来自苏黎世 OAT 登记处和瑞士海洛因辅助治疗登记处的数据，通过广义估计方程分析，对 1992 年至 2015 年的患者特征进行建模和预测，采用指数分布来预测每年阿片类药物的应用比例，直至 2018 年。

结果

共纳入了 11895 例患者的数据。美沙酮仍然是 OAT 的主要治疗药物，约三分之二的患者使用该药。在获得批准后，海洛因辅助治疗的比例迅速增加，目前稳定在 12.16%（95%置信区间：11.15-13.17）。在获得 OAT 批准后，丁丙诺啡和缓控释吗啡（SROM）的比例最初增长缓慢。虽然在 2014 年，这两种药物的比例分别为 10.2%和 10.3%，但我们的模型预测，SROM 的比例将在 2018 年进一步增加到 19.9%，此后的上限水平为 25.19%（21.40-28.98%）。SROM 患者表现出与美沙酮治疗患者相似的特征；丁丙诺啡患者的社会融合程度最高；海洛因辅助治疗患者是最同质的群体，平均年龄最高，注射经验最广泛，社会融合程度最低。