McLellan A T, Arndt I O, Metzger D S, Woody G E, O'Brien C P
Department of Psychiatry, Penn-VA Center for Studies of Addiction, Philadelphia 19104.
JAMA. 1993 Apr 21;269(15):1953-9.
To examine whether the addition of counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients.
Random assignment to one of three treatment groups for a 6-month clinical trial: (1) minimum methadone services (MMS)--methadone alone (a minimum of 60 mg/d) with no other services; (2) standard methadone services (SMS)--same dose of methadone plus counseling; or (3) enhanced methadone services (EMS)--same dose of methadone plus counseling and on-site medical/psychiatric, employment, and family therapy.
The methadone maintenance program of the Philadelphia (Pa) Veterans Affairs Medical Center.
Ninety-two male intravenous opiate users in methadone maintenance treatment.
While methadone treatment alone (MMS) was associated with reductions in opiate use, 69% of these subjects had to be "protectively transferred" from the trial because of unremitting use of opiates or cocaine, or medical/psychiatric emergencies. This was significantly different from the 41% of SMS subjects and 19% of EMS subjects who met the criteria. End-of-treatment data (at 24 weeks) showed minimal improvements among the 10 MMS patients who completed the trial. The SMS group showed significantly more and larger improvements than did the MMS group; and the EMS group showed significantly better outcomes than did the SMS group. Minimum methadone services subjects who had been "protectively transferred" to standard care showed significant reductions in opiate and cocaine use within 4 weeks.
Methadone alone (even in substantial doses) may only be effective for a minority of eligible patients. The addition of basic counseling was associated with major increases in efficacy; and the addition of on-site professional services was even more effective.
探讨增加咨询、医疗护理及心理社会服务是否能提高盐酸美沙酮疗法对阿片类药物依赖患者康复治疗的疗效。
随机分配至三个治疗组之一，进行为期6个月的临床试验：（1）最低美沙酮服务（MMS）——仅使用美沙酮（至少60毫克/天），无其他服务；（2）标准美沙酮服务（SMS）——相同剂量美沙酮加咨询；或（3）强化美沙酮服务（EMS）——相同剂量美沙酮加咨询以及现场医疗/精神科、就业和家庭治疗。
宾夕法尼亚州费城退伍军人事务医疗中心的美沙酮维持治疗项目。
92名接受美沙酮维持治疗的男性静脉注射阿片类药物使用者。
虽然仅使用美沙酮治疗（MMS）与阿片类药物使用减少有关，但这些受试者中有69%因持续使用阿片类药物或可卡因或出现医疗/精神科紧急情况而不得不从试验中“保护性转移”。这与符合标准的SMS组受试者中的41%和EMS组受试者中的19%有显著差异。治疗结束时（24周）的数据显示，完成试验的10名MMS患者改善甚微。SMS组比MMS组有显著更多且更大的改善；EMS组的结果比SMS组显著更好。已“保护性转移”至标准护理的最低美沙酮服务组受试者在4周内阿片类药物和可卡因使用量显著减少。
仅使用美沙酮（即使是大剂量）可能仅对少数符合条件的患者有效。增加基本咨询可使疗效大幅提高；增加现场专业服务则更有效。
