O'Connor P G, Oliveto A H, Shi J M, Triffleman E G, Carroll K M, Kosten T R, Rounsaville B J, Pakes J A, Schottenfeld R S
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
Am J Med. 1998 Aug;105(2):100-5. doi: 10.1016/s0002-9343(98)00194-6.
Buprenorphine is an alternative to methadone for the maintenance treatment of heroine dependence and may be effective on a thrice weekly basis. Our objective was to evaluate the effect of thrice weekly buprenorphine maintenance for the treatment of heroin dependence in a primary care clinic on retention in treatment and illicit opioid use.
Opioid-dependent patients were randomly assigned to receive thrice weekly buprenorphine maintenance in a primary care clinic that was affiliated with a drug treatment program (n = 23) or in a traditional drug treatment program (n = 23) in a 12-week clinical trial. Primary outcomes were retention in treatment and urine toxicology for opioids; secondary outcomes were opioid withdrawal symptoms and toxicology for cocaine.
Retention during the 12-week study was higher in the primary care setting (78%, 18 of 23) than in the drug treatment setting (52%, 12 of 23; P = 0.06). Patients admitted to primary care had lower rates of opioid use based on overall urine toxicology (63% versus 85%, P < 0.01) and were more likely to achieve 3 or more consecutive weeks of abstinence (43% versus 13%, P = 0.02). Cocaine use was similar in both settings.
Buprenorphine maintenance is an effective treatment for heroin dependence in a primary care setting.
丁丙诺啡是美沙酮用于海洛因依赖维持治疗的替代药物，且可能每周三次给药有效。我们的目的是评估在初级保健诊所每周三次丁丙诺啡维持治疗对海洛因依赖患者治疗保留率及非法阿片类药物使用情况的影响。
在一项为期12周的临床试验中，将阿片类药物依赖患者随机分配至与药物治疗项目相关的初级保健诊所（n = 23）或传统药物治疗项目（n = 23）接受每周三次的丁丙诺啡维持治疗。主要结局为治疗保留率及阿片类药物尿液毒理学检测结果；次要结局为阿片类药物戒断症状及可卡因毒理学检测结果。
在为期12周的研究中，初级保健机构中的治疗保留率（78%，23例中的18例）高于药物治疗机构（52%，23例中的12例；P = 0.06）。基于总体尿液毒理学检测，初级保健机构中的患者阿片类药物使用率较低（63% 对85%，P < 0.01），且更有可能实现连续3周或更长时间的戒断（43% 对13%，P = 0.02）。两个机构中的可卡因使用情况相似。
在初级保健机构中，丁丙诺啡维持治疗是治疗海洛因依赖的有效方法。
