Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study
Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study
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DOI：
10.1016/s0376-8716(00)00211-8
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发表时间：
2001-05-01
影响因子：
4.2
通讯作者：
Treacy, S
中科院分区：
文献类型：
--
作者：
Gossop, M;Marsden, J;Treacy, S
本文提供了一个详细的分析，2年的结果为351名药物滥用者分配意向治疗的基础上，美沙酮维持或美沙酮减量治疗。这两个组在使用非法药物和其他成果方面都有大幅度减少。然而，虽然大多数美沙酮维持治疗患者接受了维持治疗，但只有约三分之一的美沙酮减量患者接受了美沙酮减量治疗，许多患者实际上接受了某种形式的美沙酮维持治疗。减少患者更有可能接受低剂量的美沙酮，并且不太可能继续治疗。对于维持治疗的患者，较高剂量和治疗中的保留均与2年时非法海洛因使用的改善相关。对于减少患者，美沙酮减少越快，海洛因使用结果越差。对于两种治疗条件下的患者，海洛因使用的减少与其他结局领域的改善相关。更严重的依赖患者表现出更好的美沙酮维持治疗的结果。美沙酮减量治疗过程与不良结局相关，许多分配接受美沙酮减量治疗的患者没有按预期接受减量治疗。这就对初始治疗计划过程或治疗实施过程或两者的适当性提出了质疑。应更明确区分美沙酮维持和美沙酮减量。在治疗开始时，应向患者和临床工作人员明确治疗目标。我们建议有必要重新评估美沙酮减量治疗的目标和程序。(C)2001爱思唯尔科学爱尔兰有限公司保留所有权利。
This paper provides a detailed analysis of the 2-year outcomes for 351 drug misusers allocated on an intention-to-treat basis to methadone maintenance or methadone reduction treatments. Both groups showed substantial reductions in their use of illicit drugs and in other outcome areas. However, whereas most methadone maintenance patients received maintenance, only about one third of those allocated to methadone reduction received methadone reduction, and many actually received a form of methadone maintenance. Reduction patients were more likely to receive low doses of methadone, and were less likely to remain in treatment. For maintenance patients, higher doses and retention in treatment were both associated with improvements in illicit heroin use at 2 years. For the reduction patients, the more rapidly the methadone was reduced, the worse the heroin use outcomes. For patients in both treatment conditions, reductions in heroin use were associated with improvements in other outcome areas. The more severely dependent patients showed better outcomes in methadone maintenance. Methadone reduction treatment processes were associated with poor outcomes, and many patients who were allocated to methadone reduction treatment did not receive reduction treatment as intended. This calls into question the appropriateness of either the initial treatment planning process or the treatment delivery process, or both. A clearer distinction should be made between methadone maintenance and methadone reduction. Treatment goals should be made explicit both to the patient and to the clinical staff at the start of treatment. We suggest the need for a reappraisal of the goals and procedures of methadone reduction treatment. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.