The long-term outcomes of drug use by methadone maintenance patients
The long-term outcomes of drug use by methadone maintenance patients
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DOI：
10.1007/bf02287318
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发表时间：
2003-07-01
影响因子：
1.9
通讯作者：
Cacciola, J
中科院分区：
文献类型：
--
作者：
Bovasso, G;Cacciola, J
这项研究的目的是根据美沙酮维持治疗(MM)治疗早期发生的药物使用情况，预测美沙酮维持治疗(MM)的长期结果，而不是继续使用海洛因。在以前的研究中，多发性骨髓瘤期间首次药物使用与康复状况的措施之间的相关性很弱，这可能是因为使用的措施没有区分不同类型药物使用的趋势。在本研究中，222名完成6个月MM治疗的患者在计划服药时进行评估，在治疗的前6个月评估阿片类药物和可卡因，并在治疗开始后2年进行随访评估。使用成瘾严重程度指数评估患者的摄入状况。多发性骨髓瘤前6个月的鸦片和可卡因的使用通过尿毒学进行评估。在后续行动中使用结构化访谈和官方犯罪记录来评估结果。对治疗期间的尿毒物进行的聚类分析确定了MM患者的3个轨迹类别：(A)阿片类药物使用水平不同地高，但可卡因使用率始终较低；(B)阿片类药物和可卡因使用量低且不断减少；以及(C)可卡因使用量持续较高，但阿片类药物使用量不断减少。在观察到这些趋势后的18个月期间，C组的刑事指控明显多于B组(3倍)，但并不明显多于A组。A组和B组在刑事指控方面没有显著差异。不考虑集群成员，在MM的前6个月中，可卡因使用量增加的受试者在随访期内因药物和酒精问题住院的人数比没有增加可卡因使用量的受试者更多。这些结果提供了MM期间使用可卡因的负面后遗症的证据，强调了临床努力减少MM患者使用可卡因和其他非阿片类药物水平的重要性。
The aim of the study is to predict long-term outcomes of methadone maintenance (MM), other than continued heroin use, on the basis of drug use occurring early in MM treatment. In previous research, the weak association of initial drug use during MM with measures of rehabilitation status may be due to the use of measures that do not differentiate trends in different types of drug use. In the present study, 222 patients who completed 6 months of MM were assessed at program intake, evaluated for opiates and cocaine in the first 6 months of treatment, and given a follow-up assessment 2 years after treatment entry. The intake status of the patients was assessed using the Addiction Severity Index. Opiate and cocaine use during the first 6 months of MM was assessed by urine toxicology. Outcomes were assessed using a structured interview and official criminal records at follow-up. Cluster analysis of urine toxicologies during treatment identified 3 trajectory classes of MM patients: (A) variably high levels of opiate use, but consistently low cocaine use; (B) low and diminishing opiate and cocaine use; and (C) consistently high cocaine use, with diminishing opiate use. In an 18-month period, after these trends were observed, Cluster C had significantly more criminal charges than Cluster B had (3 times as many), but not significantly more than those of Cluster A. Clusters A and B did not differ significantly in criminal charges. Regardless of cluster membership, subjects with increasing levels of cocaine use in the first 6 months of MM had more hospitalizations for drug and alcohol problems during the follow-up period than subjects without increasing levels of cocaine use had. The results provide evidence of negative sequelae of cocaine use during MM that underscore the importance of clinical efforts to reduce levels of cocaine and other nonopiate drug use by MM patients.