Monwell Bodil, Gerdner Arne
a a Psychiatric Clinic , County Hospital Ryhov , Jönköping , Sweden.
b b Jönköping University, School of Health and Welfare, Department of Social Work , Jönköping , Sweden.
Nord J Psychiatry. 2019 Jan;73(1):24-30. doi: 10.1080/08039488.2018.1539120. Epub 2019 Jan 12.
Although efficacy studies of opioid maintenance treatment (OMT) have shown evidence of treatment benefits, there is still need for studies on its effectiveness in natural clinical processes. This study investigates the development in health, substance use and social conditions of those who applied for OMT, including those denied access or discharged.
First, persons assessed for admittance in 2005-2011 (n = 127) were categorized into four trajectory groups based on whether they were admitted or denied (n = 19), discharged (n = 31), readmitted (n = 21) or had been undergoing OMT without interruption (n = 56). Second, 99 of these, the analytical sample, were interviewed at follow-up using (a) the Addiction Severity Index (ASI) for seven problem-areas and housing, and (b) self-rated change in 11 problem areas. The ASI was compared to baseline interviews after 55 months (mean). Third, outcomes within groups was studied in relation to alternative interventions.
Within the analytical sample, those denied OMT showed no improvements at group level, those discharged had some improvements, more if readmitted than if not and those with uninterrupted OMT showed the most comprehensive improvements. Those outside OMT, denied and discharged, had considerable mortality risks related to ongoing drug use, especially in lack of well-planned alternative interventions.
Improvements strongly relate to access to OMT. This study underscores that access to OMT improves the situation in all areas investigated and decreases the risk for drug-related death. It underscores the importance of two major risk situations, i.e. being denied OMT and being discharged.
尽管阿片类药物维持治疗（OMT）的疗效研究已证明该治疗有益，但仍需对其在自然临床过程中的有效性进行研究。本研究调查了申请OMT者（包括被拒绝准入或出院者）的健康、物质使用及社会状况的发展情况。
首先，将2005年至2011年接受入院评估的人员（n = 127）根据其是否被准入或拒绝（n = 19）、出院（n = 31）、再次入院（n = 21）或持续接受OMT（n = 56）分为四个轨迹组。其次，对其中99人（分析样本）进行随访访谈，使用（a）针对七个问题领域和住房情况的成瘾严重程度指数（ASI），以及（b）11个问题领域的自评变化情况。将ASI与55个月（平均）后的基线访谈结果进行比较。第三，研究了各组内的结果与替代干预措施的关系。
在分析样本中，被拒绝OMT者在组水平上未显示出改善，出院者有一定改善，再次入院者比未再次入院者改善更多，而持续接受OMT者显示出最全面的改善。未接受OMT的被拒绝者和出院者因持续吸毒面临相当大的死亡风险，尤其是在缺乏精心规划的替代干预措施的情况下。
改善情况与获得OMT的机会密切相关。本研究强调，获得OMT可改善所有调查领域的状况并降低药物相关死亡风险。它强调了两种主要风险情况的重要性，即被拒绝OMT和出院。
