Perneger T V, Giner F, del Rio M, Mino A
Institute of Social and Preventive Medicine, University of Geneva Medical School, CH-1211 Geneva 4, Switzerland.
BMJ. 1998 Jul 4;317(7150):13-8. doi: 10.1136/bmj.317.7150.13.
To evaluate an experimental heroin maintenance programme.
Randomised trial.
Outpatient clinic in Geneva, Switzerland.
Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments.
Patients in the experimental programme (n=27) received intravenous heroin and other health and psychosocial services. Control patients (n=24) received any other conventional drug treatment (usually methadone maintenance).
Self reported drug use, health status (SF-36), and social functioning.
25 experimental patients completed 6 months in the programme, receiving a median of 480 mg of heroin daily. One experimental subject and 10 control subjects still used street heroin daily at follow up (difference 44%; 95% confidence interval 16% to 71%). Health status scores that improved significantly more in experimental subjects were mental health (0.58 SD; 0.07 to 1.10), role limitations due to emotional problems (0.95 SD; 0.11 to 1.79), and social functioning (0.65 SD; 0.03 to 1.26). Experimental subjects also significantly reduced their illegal income and drug expenses and committed fewer drug and property related offences. There were no benefits in terms of work, housing situation, somatic health status, and use of other drugs. Unexpectedly, only nine (38%) control subjects entered the heroin maintenance programme at follow up.
A heroin maintenance programme is a feasible and clinically effective treatment for heroin users who fail in conventional drug treatment programmes. Even in this population, however, another attempt at methadone maintenance may be successful and help the patient to stop using injectable opioids.
评估一项实验性海洛因维持治疗项目。
随机试验。
瑞士日内瓦的门诊诊所。
从社区招募的海洛因成瘾者，他们处于社会边缘地位，健康状况不佳，且之前至少两次戒毒治疗均告失败。
实验项目组患者（n = 27）接受静脉注射海洛因及其他健康和心理社会服务。对照组患者（n = 24）接受任何其他常规药物治疗（通常为美沙酮维持治疗）。
自我报告的药物使用情况、健康状况（SF - 36量表）和社会功能。
25名实验患者完成了该项目6个月的治疗，每日海洛因摄入量中位数为480毫克。随访时，1名实验对象和10名对照对象仍每日使用街头海洛因（差异44%；95%置信区间16%至71%）。实验对象中改善明显更多的健康状况评分包括心理健康（0.58标准差；0.07至1.10）、因情绪问题导致的角色受限（0.95标准差；0.11至1.79）和社会功能（0.65标准差；0.03至1.26）。实验对象还显著减少了非法收入和毒品开支，涉及毒品和财产的犯罪行为也减少。在工作、住房状况、躯体健康状况及其他药物使用方面未观察到益处。出乎意料的是，随访时仅有9名（38%）对照对象进入了海洛因维持治疗项目。
对于在常规戒毒治疗项目中失败的海洛因使用者，海洛因维持治疗项目是一种可行且临床有效的治疗方法。然而，即使在这一人群中，再次尝试美沙酮维持治疗也可能成功，并帮助患者停止使用注射用阿片类药物。
