School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
Population Health Medicine, Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland.
PLoS One. 2020 May 14;15(5):e0232086. doi: 10.1371/journal.pone.0232086. eCollection 2020.
Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout.
A systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided.
67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST.
Younger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies.
阿片类物质替代治疗（OST）的保留与所有原因和过量死亡率的大幅降低有关。本系统评价旨在确定支持 OST 保留的保护因素，以及治疗中断的风险因素。
使用 MEDLINE、Embase、PsycInfo、CINAHL 和 Web of Science（2001 年 1 月至 2019 年 10 月）进行系统搜索。纳入报告 OST 保留率和与 OST 保留相关因素的随机对照试验（RCT）和观察性队列研究。根据莫兹利成瘾概况（Maudsley Addiction Profile）探讨与治疗保留和脱落相关的因素。提供叙述性综合。
本综述纳入了 67 项研究（4 项 RCT 和 63 项观察性队列研究；N=294592），均评估了与 OST 保留或治疗脱落相关的因素。观察性研究的中位保留率在 12 个月时约为 57%，在 3 年时降至 38.4%。就治疗环境、OST 类型、风险因素评估、结局确定和随访时间而言，纳入的研究在性质上存在异质性。虽然存在这种方法学上的异质性使得很难综合结果，但有限的证据支持许多因素对保留的影响，包括年龄、物质使用、OST 药物剂量、法律问题和对 OST 的态度。
年龄较小、物质使用尤其是可卡因和海洛因使用、美沙酮剂量较低、犯罪活动/监禁以及对 MMT 的消极态度似乎与 OST 保留率降低有关。需要有一个关于保留的共识定义，以便在未来的研究中进行比较。
