Methadone maintenance treatment: the balance between life-saving treatment and fatal poisonings
Methadone maintenance treatment: the balance between life-saving treatment and fatal poisonings
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DOI：
10.1111/j.1360-0443.2006.01714.x
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发表时间：
2007-03-01
期刊：
影响因子：
6
通讯作者：
Thiblin, I.
中科院分区：
文献类型：
--
作者：
Fugelstad, A.;Stenbacka, M.;Thiblin, I.
目的确定1988年至2000年期间斯德哥尔摩美沙酮方案的总死亡率，以及同期斯德哥尔摩地区与美沙酮治疗和致命美沙酮中毒有关的死亡率。方法这项研究包括在研究期间在斯德哥尔摩接触过美沙酮方案的所有个人(n=848)，包括那些已经出院的患者和那些申请但没有接受美沙酮治疗的阿片类药物使用者。在同一时期，还分析了斯德哥尔摩法医系在血液或尿液中发现美沙酮的法医检查对象的所有死亡病例。结果继续接受维持治疗的阿片吸毒者死亡率较低，91%的死者死于自然原因，大多数与入院前获得的艾滋病毒或丙型肝炎有关。与继续接受治疗的患者相比，那些从美沙酮治疗中出院的患者死于非自然原因的风险高出20倍。大多数人死于海洛因注射(“过量”)。发现了89例致命的美沙酮中毒病例，但其中只有两例有证据表明是维持治疗导致的渗漏。结论“高门槛方案”是安全的，只要患者仍在接受治疗，且因方案渗漏而死亡的病例极少。然而，从该方案出院的人死亡率很高，斯德哥尔摩的海洛因使用者中只有一小部分人申请治疗。
Aim To determine the total mortality related to the Stockholm methadone programme during the period 1988 2000, both the mortality related to the treatment and fatal methadone intoxications in the Stockholm area during the same period. Methods The study comprised all individuals (n = 848) who had been in contact with the methadone programme in Stockholm during the study period, including those patients who had been discharged from treatment and those opiate users who had applied for but not received methadone treatment. All deaths that had been the subject of medico-legal examination at the Department of Forensic Medicine in Stockholm where methadone was found in blood or urine were also analysed during the same period. Results The mortality was lower among those opiate users who remained in maintenance treatment and 91% of the deceased individuals had died due to natural causes, in most cases related to HIV or hepatitis C, acquired before admission to the programme. Those who had been discharged from methadone treatment had a 20 times higher risk of dying from unnatural causes compared to the patients who remained in treatment. The majority died due to heroin injections ('overdoses'). Eighty-nine cases of fatal methadone intoxication were found, but in only two of these cases was there evidence of leakage from maintenance treatment. Conclusion The 'high threshold programme' is safe as long as the patients remain in treatment and there are very few deaths due to leakage from the programme. However, there is a high mortality among those discharged from the programme and only a minority of the heroin users in Stockholm had applied for treatment.