美沙酮维持治疗期间的海洛因使用：美沙酮剂量和可卡因使用的重要性。
Heroin use during methadone maintenance treatment: the importance of methadone dose and cocaine use.
作者信息
Hartel D M, Schoenbaum E E, Selwyn P A, Kline J, Davenny K, Klein R S, Friedland G H
机构信息
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
出版信息
Am J Public Health. 1995 Jan;85(1):83-8. doi: 10.2105/ajph.85.1.83.
Abstract
OBJECTIVES
The purpose of this study was to examine factors associated with heroin use during methadone maintenance treatment.
METHODS
Logistic regression statistical models were used to examine data obtained in a cross-sectional sample of 652 methadone patients.
RESULTS
Heroin use during the 3 months prior to interview was shown to be greatest among (1) patients maintained on methadone dosages of less than 70 mg/day (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.3, 3.4) and (2) patients who used cocaine during treatment (adjusted OR = 5.9, 95% CI = 3.8, 9.1). These results were independent of treatment duration, treatment compliance, alcohol use, and socioeconomic factors. Cocaine users were more likely than nonusers of cocaine to use heroin at all methadone dosage levels.
CONCLUSIONS
This study confirms and extends past research showing high-dose methadone maintenance to be important to heroin abstinence. Further investigation of the independent association between heroin use and cocaine use is needed.
摘要
目的
本研究旨在探讨美沙酮维持治疗期间与海洛因使用相关的因素。
方法
采用逻辑回归统计模型分析从652名美沙酮治疗患者的横断面样本中获取的数据。
结果
在接受访谈前3个月内使用过海洛因的患者中，（1）接受每日剂量低于70毫克美沙酮维持治疗的患者（校正比值比[OR]=2.1，95%置信区间[CI]=1.3，3.4）以及（2）治疗期间使用过可卡因的患者（校正OR=5.9，95%CI=3.8，9.1）使用海洛因的情况最为严重。这些结果不受治疗时长、治疗依从性、酒精使用情况及社会经济因素的影响。在所有美沙酮剂量水平下，可卡因使用者比未使用可卡因者更有可能使用海洛因。
结论
本研究证实并拓展了以往的研究，表明高剂量美沙酮维持治疗对戒除海洛因至关重要。有必要进一步研究海洛因使用与可卡因使用之间的独立关联。
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本文引用的文献
1
Dose-response effects of methadone in the treatment of opioid dependence.美沙酮治疗阿片类物质依赖的剂量-效应关系
Ann Intern Med. 1993 Jul 1;119(1):23-7. doi: 10.7326/0003-4819-119-1-199307010-00004.
2
Methadone dose and heroin use during maintenance treatment.维持治疗期间的美沙酮剂量与海洛因使用情况。
Addiction. 1993 Jan;88(1):119-24. doi: 10.1111/j.1360-0443.1993.tb02769.x.
3
Methadone disposition in patients with chronic liver disease.慢性肝病患者体内美沙酮的处置情况。
Clin Pharmacol Ther. 1981 Sep;30(3):353-62. doi: 10.1038/clpt.1981.172.
4
ACTH, cortisol and beta-endorphin response to metyrapone testing during chronic methadone maintenance treatment in humans.人类慢性美沙酮维持治疗期间促肾上腺皮质激素、皮质醇和β-内啡肽对甲吡酮试验的反应。
Neuropeptides. 1984 Dec;5(1-3):277-8. doi: 10.1016/0143-4179(84)90081-7.
5
Narcotic blockade.麻醉性阻滞
Arch Intern Med. 1966 Oct;118(4):304-9.
6
Patterns of cocaine use among methadone clients.美沙酮治疗患者中可卡因的使用模式。
Int J Addict. 1985 Aug;20(8):1163-75. doi: 10.3109/10826088509056357.
7
Abstinence symptomatology and psychiatric diagnosis in cocaine abusers. Clinical observations.可卡因滥用者的禁欲症状学与精神科诊断。临床观察。
Arch Gen Psychiatry. 1986 Feb;43(2):107-13. doi: 10.1001/archpsyc.1986.01800020013003.
8
Inadequate plasma concentrations in some high-dose methadone maintenance patients.一些高剂量美沙酮维持治疗患者的血浆浓度不足。
Am J Psychiatry. 1987 Oct;144(10):1349-50. doi: 10.1176/ajp.144.10.1349.
9
Cocaine and other stimulants. Actions, abuse, and treatment.可卡因及其他兴奋剂：作用、滥用与治疗
N Engl J Med. 1988 May 5;318(18):1173-82. doi: 10.1056/NEJM198805053181806.
10
Role of drug-abuse treatment in limiting the spread of AIDS.药物滥用治疗在限制艾滋病传播中的作用。
Rev Infect Dis. 1988 Mar-Apr;10(2):377-84. doi: 10.1093/clinids/10.2.377.
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