Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study.
Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study.
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DOI：
10.1016/s2214-109x(16)30303-5
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发表时间：
2017-03
期刊：
影响因子：
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通讯作者：
Kamarulzaman A
中科院分区：
文献类型：
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作者：
Wegman MP;Altice FL;Kaur S;Rajandaran V;Osornprasop S;Wilson D;Wilson DP;Kamarulzaman A
在整个东亚和东南亚，将吸毒者拘留在强制戒毒拘留中心是很常见的。治疗物质使用障碍的循证药理学疗法，如美沙酮类阿片激动剂治疗，在这些环境中通常不可用。我们利用了一个独特的机会，在马来西亚，cddc与提供美沙酮的自愿药物治疗中心（VTCs）共存，比较了从cddc过渡到VTCs维持美沙酮的个体阿片类药物复发的时间和发生率（使用尿药检测量）。我们对在马来西亚巴生谷接受治疗的18岁及以上阿片类药物依赖个体进行了一项平行、两组、前瞻性观察研究：cddc和VTCs。我们使用顺序抽样来招募个体。在发展中国家发展中心接受评估的个人被要求参加咨询会议和体力劳动等服务。职业培训中心中接受评估的个体除了美沙酮治疗外，还可以自愿使用cddc中提供的许多成分。我们进行了尿药检和行为访谈，在基线和释放后1、3、6、9和12个月对个体进行评估。主要结局是通过接受基线访谈和至少一次尿药检（我们的分析样本）的个体进行尿药检确认的社区阿片类药物释放后复发的时间。使用时间-事件法比较两组之间的复发率。该研究已在ClinicalTrials.gov注册（NCT02698098）。在2012年7月17日至2014年8月21日期间，我们筛选了168名CDDC参与者和113名VTC住院患者；其中，89名来自发展中国家，95名来自职业培训中心，被纳入我们的分析样本。两组的基线特征相似。在未经调整的分析中，与VTC参与者相比，CDDC参与者在释放阿片类药物后的复发速度更快（中位复发时间为31天[IQR 26-32] vs 352天[256 -不可估计]，log rank检验，p< 0.0001）。在调整控制变量和治疗权重的逆倾向后，VTC参与者的阿片类药物复发风险降低了84% （95% CI 75-90）。时变效应模型显示，在社区的前50天发生了最大的风险比降低，为91% （95% CI 83-96）。与接受美沙酮等循证治疗的个体相比，cddc中的阿片类药物依赖个体在释放后更容易复发，而且更快，这表明cddc在治疗阿片类药物使用障碍方面没有作用。世界银行集团、多丽丝·杜克慈善基金会、国家药物滥用研究所、澳大利亚国家卫生与医学研究理事会、国家精神卫生研究所以及马来西亚大学-马来西亚高等教育部高影响力研究补助金。
Detention of people who use drugs into compulsory drug detention centres (CDDCs) is common throughout East and Southeast Asia. Evidence-based pharmacological therapies for treating substance use disorders, such as opioid agonist treatments with methadone, are generally unavailable in these settings. We used a unique opportunity where CDDCs coexisted with voluntary drug treatment centres (VTCs) providing methadone in Malaysia to compare the timing and occurrence of opioid relapse (measured using urine drug testing) in individuals transitioning from CDDCs versus methadone maintenance in VTCs. We did a parallel, two-arm, prospective observational study of opioid-dependent individuals aged 18 years and older who were treated in Malaysia in the Klang Valley in two settings: CDDCs and VTCs. We used sequential sampling to recruit individuals. Assessed individuals in CDDCs were required to participate in services such as counselling sessions and manual labour. Assessed individuals in VTCs could voluntarily access many of the components available in CDDCs, in addition to methadone therapy. We undertook urinary drug tests and behavioural interviews to assess individuals at baseline and at 1, 3, 6, 9, and 12 months post-release. The primary outcome was time to opioid relapse post-release in the community confirmed by urinary drug testing in individuals who had undergone baseline interviewing and at least one urine drug test (our analytic sample). Relapse rates between the groups were compared using time-to-event methods. This study is registered at ClinicalTrials.gov (NCT02698098). Between July 17, 2012, and August 21, 2014, we screened 168 CDDC attendees and 113 VTC inpatients; of these, 89 from CDDCs and 95 from VTCs were included in our analytic sample. The baseline characteristics of the two groups were similar. In unadjusted analyses, CDDC participants had significantly more rapid relapse to opioid use post-release compared with VTC participants (median time to relapse 31 days [IQR 26–32] vs 352 days [256–unestimable], log rank test, p<0·0001). VTC participants had an 84% (95% CI 75–90) decreased risk of opioid relapse after adjustment for control variables and inverse propensity of treatment weights. Time-varying effect modelling revealed the largest hazard ratio reduction, at 91% (95% CI 83–96), occurs during the first 50 days in the community. Opioid-dependent individuals in CDDCs are significantly more likely to relapse to opioid use after release, and sooner, than those treated with evidence-based treatments such as methadone, suggesting that CDDCs have no role in the treatment of opioid-use disorders. The World Bank Group, Doris Duke Charitable Foundation, National Institute on Drug Abuse, Australian National Health & Medical Research Council, National Institute of Mental Health, and the University of Malaya-Malaysian Ministry of Higher Education High Impact Research Grant.