The impact of ongoing illicit drug use on methadone adherence in illicit drug users receiving treatment for HIV in a directly observed therapy program
The impact of ongoing illicit drug use on methadone adherence in illicit drug users receiving treatment for HIV in a directly observed therapy program
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DOI：
10.1016/j.drugalcdep.2007.02.007
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发表时间：
2007-07-10
影响因子：
4.2
通讯作者：
Conway, Brian
中科院分区：
文献类型：
--
作者：
Raffa, Jesse D.;Grebely, Jason;Conway, Brian
导言：评估阿片类激动剂治疗方案有效性的研究通常评估药物戒断或治疗保留作为其主要结果。然而，在许多情况下（例如，美沙酮维持计划中的直接观察治疗（DOT）计划），美沙酮依从性是一个极其相关的临床结果。我们试图在DOT治疗hiv感染的项目中评估持续非法药物使用对美沙酮依从性的影响。方法：患者被纳入DOT计划，美沙酮和艾滋病药物由社区药剂师共同管理。药物使用（安非他明、苯二氮卓类、可卡因和阿片类药物）通过重复尿液分析结果进行评估。美沙酮依从性以服用美沙酮的天数计算。结果：持续用药和多物质使用是常见的，60例患者中只有4例戒除所有非法药物使用。总体美沙酮依从性为84.5%。使用安非他明（不使用苯二氮卓和可卡因），使用苯二氮卓（不使用安非他明）和高剂量美沙酮与更高的美沙酮依从性相关。当患者使用苯二氮卓类药物或可卡因时，与使用安非他明相关的任何积极作用都被否定了。此外，阿片类药物的使用与美沙酮依从性降低有关。讨论：许多非法药物对美沙酮依从性的影响可能与使用其他治疗结果的报告不同。2007爱思唯尔爱尔兰有限公司版权所有。
Introduction: Studies evaluating the effectiveness of opioid agonist therapy programs typically evaluate drug abstinence or treatment retention as their primary outcomes. However, in many circumstances (e.g. directly observed therapy (DOT) programs within methadone maintenance programs), methadone adherence is an extremely relevant clinical outcome. We sought to evaluate the impact of ongoing illicit drug use on methadone adherence within a DOT program for the treatment of HIV-infection.Methods: Patients were enrolled in a DOT program, where methadone and HIV medication are co-administered by a community pharmacist. Drug use (amphetamines, benzodiazepines, cocaine, and opiates) was assessed by repeated urinalysis results. Methadone adherence was calculated as the fraction of days methadone was administered.Results: Ongoing drug use, and poly-substance use was common, with only 4 of 60 patients abstaining from all illicit drug use. Overall methadone adherence was 84.5%. Amphetamine use (without benzodiazepine and cocaine use), benzodiazepine use (without amphetamines) and higher methadone doses were associated with higher methadone adherence. When patients used benzodiazepines or cocaine, any positive effect associated with amphetamine use was negated. In addition, opiate use was associated with decreased methadone adherence.Discussion: The effect of many illicit drugs on methadone adherence may differ from reports using other treatment outcomes. (C) 2007 Elsevier Ireland Ltd. All rights reserved.