Brooner R, Kidorf M, King V, Beilenson P, Svikis D, Vlahov D
Department of Psychiatry and Behavioral Sciences, John Hopkins University (JHU) School of Medicine, Baltimore, Md 21224, USA.
Public Health Rep. 1998 Jun;113 Suppl 1(Suppl 1):129-39.
Although lowering incidence rates of human immunodeficiency virus (HIV) transmission is the primary goal of needle exchange programs (NEPs), other desirable outcomes are possible. Referring exchange participants to more comprehensive drug abuse treatment programs has the potential to reduce or eliminate the use of drugs. This possibility was evaluated by comparing the treatment responses of new admissions with an outpatient opioid agonist treatment program in Baltimore, Maryland.
New admissions (1994 - 1997) to an opioid agonist treatment program were first grouped by referral source (needle exchange, n = 82 vs. standard referrals, n = 243) and then compared on admission demographic and clinical variables and response to treatment during the first three months. Outcome measures included retention rates, self-reported drug use and injecting frequencies, self-reported illegal activities for profit, and results from weekly urinalysis testing for opioids and cocaine.
Patients from the NEP were significantly older and more likely to be male, African American, and unemployed than standard referral patients. Needle exchange patients also had a greater baseline severity of drug use than patients in the standard referral group. Despite these baseline differences, both groups achieved comparably good short-term treatment outcomes (including reduced drug use and criminal activity for profit); treatment retention was also good, although slightly better in the standard referral group (88% vs. 76%).
These data demonstrate the feasibility and merits of creating strong linkages between NEPs and more comprehensive drug abuse treatment clinics.
尽管降低人类免疫缺陷病毒（HIV）传播的发生率是针头交换项目（NEPs）的主要目标，但其他理想结果也是有可能实现的。将参与交换的人员转介到更全面的药物滥用治疗项目有可能减少或消除药物使用。通过比较马里兰州巴尔的摩市一家门诊阿片类激动剂治疗项目新入院患者的治疗反应来评估这种可能性。
将阿片类激动剂治疗项目的新入院患者（1994 - 1997年）首先按转介来源分组（针头交换组，n = 82；标准转介组，n = 243），然后比较入院时的人口统计学和临床变量以及头三个月的治疗反应。结果指标包括留存率、自我报告的药物使用和注射频率、自我报告的以盈利为目的的非法活动，以及每周进行的阿片类药物和可卡因尿液分析检测结果。
与标准转介患者相比，来自针头交换项目的患者年龄显著更大，更可能为男性、非裔美国人且失业。针头交换项目患者的药物使用基线严重程度也高于标准转介组患者。尽管存在这些基线差异，但两组在短期治疗结果方面都取得了相当不错的成绩（包括减少药物使用和以盈利为目的的犯罪活动）；治疗留存情况也良好，尽管标准转介组略好一些（88%对76%）。
这些数据证明了在针头交换项目与更全面的药物滥用治疗诊所之间建立紧密联系的可行性和优点。
