Evaluation of an implementation of methadone maintenance treatment in China.
Evaluation of an implementation of methadone maintenance treatment in China.
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DOI：
10.1016/j.drugalcdep.2015.10.001
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发表时间：
2015-12-01
影响因子：
4.2
通讯作者：
Chawarski MC
中科院分区：
文献类型：
--
作者：
Marienfeld C;Liu P;Wang X;Schottenfeld R;Zhou W;Chawarski MC
美沙酮维持治疗（MMT）可减少阿片类药物使用障碍的危害，并正在中国迅速推广。本研究评估了 MMT 系统在中国武汉的实际实施情况。使用从 2010 年收集的 8,811 名患者的电子病历中提取的数据来计算每位患者的每日美沙酮剂量处方指数、依从性指数、漏服剂量后的剂量调整、阿片类药物阳性尿检率、自我报告的吸毒情况、注射吸毒情况 (IDU) 以及 MMT 暴露持续时间。 68.5% 的患者每日处方剂量为 60 mg 及以上。依从性参差不齐：51% 的患者在治疗日的 60% 到 60% 的时间内就诊，26% 的患者在 80% 至 100% 的治疗日内就诊；长期 MMT 暴露患者的依从率显着高于短期 MMT 暴露患者。给药日中断之前和之后立即分配的剂量之间的差异范围为 0 至 7 mg，与中断的长度或规定的给药水平无关。阿片类药物阳性检测总体率为 20%； 45% 的患者至少有一项阿片类药物检测结果呈阳性； 29% 的人报告了过去一个月吸毒的情况，其中 53% 的人报告了过去一个月注射毒品的情况。依从性和 MMT 暴露持续时间与阿片类药物阴性尿液检测的比例显着相关（分别为 r=0.355，p<0.001；r=0.351，p<0.001）。男性和女性的治疗具有可比性。缺勤后提供安全的美沙酮剂量和提高每日出勤率被确定为优先改进领域。
Methadone maintenance treatment (MMT) reduces the harms of opioid use disorder and is being rapidly scaled-up in China. This study evaluated the real-world implementation of MMT system in Wuhan, China. Data extracted from electronic medical records collected in 2010 on 8,811 patients were used to compute for each patient indices of the prescribed and consumed daily methadone doses, an adherence index, dose adjustments following missed doses, the rates of opiate positive urine tests, self-reported drug use, injection drug use (IDU), and the duration of MMT exposure. The modal daily doses prescribed were 60 mg and above for 68.5% of patients. Adherence was variable: 51% of patients attended less than 60% and 26% attended 80% to 100% of their treatment days; and patients with long MMT exposure had significantly higher adherence rates than patients with short MMT exposure. The differences between doses dispensed immediately before and after the interruption in dosing days ranged from 0 to 7 mg, independently of the length of the interruption or the prescribed dosing level. The overall rate of opiate positive tests was 20%; 45% of patients had at least one opiate positive test; 29% reported past month drug use and 53% of them reported past month IDU. Adherence and MMT exposure duration correlated significantly with the proportion of opiate negative urine tests (r=0.355, p<0.001; r=0.351, p<0.001, respectively). Treatment for males and females was comparable. Provision of safe methadone dosing after absences and improving daily attendance are identified as priority improvement areas.