McCarty Dennis, Chan Brian, Bougatsos Christina, Grusing Sara, Chou Roger
Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, BICC, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States; OHSU-PSU School of Public Health, Oregon Health & Science University, CB669, United States.
Department of Medicine, OHSU Medical School, Oregon Health & Science University, United States.
Drug Alcohol Depend. 2021 Aug 1;225:108766. doi: 10.1016/j.drugalcdep.2021.108766. Epub 2021 May 21.
Opioid treatment programs (OTPs) may provide interim methadone services - up to 120 days of methadone dosing without counseling. Regulatory requirements limit use of interim methadone services. We summarized the evidence on interim methadone and other strategies to minimize wait lists in OTPs.
A scoping review selected studies of interim methadone and strategies that facilitated access to methadone. Randomized trials and controlled observational studies were prioritized; if evidence was lacking, lesser quality evidence was included.
Six studies examined interim methadone and three studies examined alternatives: low threshold services, an open access policy, and a medication first policy. The studies included four randomized clinical trials of interim methadone (with three follow-up reports and five secondary analyses), one prospective cohort of interim methadone, one retrospective cohort of interim methadone, one randomized trial of low threshold services and two pre-post assessments of changes in program or state policies. The clinical trials and observational cohorts reported reductions in heroin use during interim methadone and participants were more likely to enter OTPs than those on wait lists. Retention rates in interim methadone were similar to patients in active treatment. Studies testing strategies to facilitate access to methadone were effective without interim methadone's restrictions.
Interim methadone appears to be effective and safe compared to wait list controls and provided similar outcomes to standard services. Interim methadone could increase access to OTPs. More research is needed on the alternative approaches to facilitate access to medication with comparisons to wait list controls and assessment of patient outcomes.
阿片类药物治疗项目（OTP）可能会提供临时美沙酮服务——即长达120天的美沙酮给药且无需咨询。监管要求限制了临时美沙酮服务的使用。我们总结了关于临时美沙酮及其他减少OTP等候名单策略的证据。
一项范围综述选取了关于临时美沙酮及促进美沙酮获取策略的研究。优先考虑随机试验和对照观察性研究；若缺乏此类证据，则纳入质量稍低的证据。
六项研究考察了临时美沙酮，三项研究考察了替代方案：低门槛服务、开放获取政策和药物优先政策。这些研究包括四项临时美沙酮的随机临床试验（有三项随访报告和五项二次分析）、一项临时美沙酮的前瞻性队列研究、一项临时美沙酮的回顾性队列研究、一项低门槛服务的随机试验以及两项项目或州政策变化的前后评估。临床试验和观察性队列研究报告称，在临时美沙酮治疗期间海洛因使用减少，且与等候名单上的人相比，参与者更有可能进入OTP。临时美沙酮治疗的留存率与接受积极治疗的患者相似。测试促进美沙酮获取策略的研究在没有临时美沙酮限制的情况下是有效的。
与等候名单对照相比，临时美沙酮似乎有效且安全，并且与标准服务产生相似的结果。临时美沙酮可以增加进入OTP的机会。需要对促进药物获取的替代方法进行更多研究，与等候名单对照进行比较并评估患者结局。
