Office-based treatment for opioid dependence: Reaching new patient populations
Office-based treatment for opioid dependence: Reaching new patient populations
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DOI：
10.1176/appi.ajp.158.8.1200
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发表时间：
2001-08-01
影响因子：
17.7
通讯作者：
Kosten, TR
中科院分区：
文献类型：
--
作者：
Fiellin, DA;Rosenheck, RA;Kosten, TR
海洛因成瘾是一个代价高昂且对个人具有破坏性的公共卫生问题，非专业媒体经常将其描述为主要面对美国人口中较低社会经济阶层的问题。然而，流行病学研究表明，阿片类药物成瘾每年影响810，000人，代表美国社会的各个阶层，以及他们的家庭和社区，每年的费用估计为210亿美元。这种疾病最有效的治疗方法是使用美沙酮或左旋α-乙酰美沙酮等药物维持阿片类药物（2）。在这种治疗中，法律的，长效的，医学管理的药物取代非法药物，并阻止痛苦的戒断综合征和渴望以及主观药物高，激励继续使用（3）。然而，由于公共资金有限，当地反对建立新诊所，州许可证限制以及旨在防止药物从其医疗用途转移并作为街头滥用物质转售的严格联邦法规，这种治疗受到了严重限制。这些规定限制了这些药物的交付，专门的美沙酮诊所，往往位于不受欢迎的社区，是不方便的，并要求几乎每天出席。由于这些原因，只有大约15%的海洛因依赖者参与美沙酮或左旋-α-乙酰美沙酮治疗，尽管研究清楚地表明，这种治疗在促进持续戒断方面比无药物门诊治疗更有效（4-6）。虽然在开发更具成本效益的门诊戒毒方法方面取得了进展，但这种方法的长期效用有限，因为戒毒后经常复发，即使是在有良好社会支持的积极性很高的患者中也是如此（7-10）。
Heroin addiction is a costly and personally destructive public health problem that is often portrayed in the nonprofessional media as a problem primarily facing the lower socioeconomic segment of the US population. Epidemiologic studies, however, show that opioid addiction affects 810,000 people each year, representing all segments of American society, as well as their families and communities, with annual costs estimated at $21 billion (1). The most effective treatment for this disorder is opioid maintenance with medications such as methadone or levo-alpha-acetyl methadol (2). In this treatment, legal, long-acting, medically managed medications replace illegal drugs and block both the painful withdrawal syndrome and craving as well as the subjective drug high that motivate continued use (3). This treatment, however, has been significantly restricted by limited public funding, local opposition to the establishment of new clinics, state licensing restrictions, and stringent federal regulations designed to prevent the medication from being diverted from its medical use and resold as a substance of abuse on the street. These regulations restrict the delivery of these medications to specialized methadone clinics that are often located in undesirable neighborhoods, are inconvenient to reach, and require almost daily attendance. For these reasons, only about 15% of the total heroin-dependent population participates in methadone or levo-alpha-acetyl methadol treatment, although studies clearly demonstrate that this therapy is more effective than drug-free outpatient care in promoting sustained abstinence (4–6). Although progress has been made in developing more cost-effective methods for outpatient detoxification, this approach has limited long-term usefulness because of frequent relapses after detoxification, even in well-motivated patients with good social supports (7–10).