The impact of harm-reduction-based methadone treatment on mortality among heroin users
The impact of harm-reduction-based methadone treatment on mortality among heroin users
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DOI：
10.2105/ajph.91.5.774
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发表时间：
2001-05-01
影响因子：
12.7
通讯作者：
van Ameijden, EJC
中科院分区：
文献类型：
--
作者：
Langendam, MW;van Brussel, GHA;van Ameijden, EJC
目标.本研究的目的是调查减少危害为基础的美沙酮项目对海洛因使用者死亡率的影响。在阿姆斯特丹队列研究的827名参与者中进行了一项前瞻性队列调查，使用泊松回归来确定美沙酮维持治疗特征（剂量，计划出席频率和计划类型），这些特征与自然原因和过量死亡率显著且独立相关。从1985年到1996年，89名参与者死于自然原因，31人死于过量。在调整HIV和体重不足状态后，离开美沙酮治疗的受试者的自然原因死亡率增加（相对风险[RR] = 2.38，95%置信区间[CI] = 1.28，4.55）。离开治疗也与较高的过量死亡率有关，但仅在注射吸毒者中（RR= 4.55，95%CI = 1.89，10.00）。以减少伤害为基础的美沙酮治疗可以容忍非法药物的使用，这与自然原因和过量用药造成的死亡率下降密切相关。提供美沙酮本身，加上社会医疗保健，似乎比实际美沙酮剂量更重要。
Objectives. The purpose of this study was to investigate the impact of harm-reduction-based methadone programs on mortality among heroin users.Methods. A prospective cohort investigation was conducted among 827 participants in the Amsterdam Cohort Study Poisson regression was used to, identify methadone maintenance treatment characteristics (dosage, frequency of program attendance, and type of program) that are significantly and independently associated with mortality due to natural causes and overdose.Results. From 1985 to 1996, 89 participants died of natural causes, and 31 died as a result of an overdose. After adjustment for HIV and underweight status, there was an increase in natural-cause mortality among subjects who left methadone treatment (relative risk [RR] = 2.38, 95 % confidence interval [CI] = 1.28, 4.55). Leaving treatment was also related to higher overdose mortality but only among injection drug users (RR= 4.55, 95% Cl= 1.89, 10.00).Conclusions. Harm-reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdoses. Provision of methadone in itself, together with social-medical care, appears more important than the actual methadone dosage.