AIDS DEMONSTATION--THREE LEVELS OF METHADONE MAINTENANCE

艾滋病示范--美沙酮维持的三个级别

• 批准号: 3212283
• 负责人: Anna Rose Childress
• 金额: $ 93.89万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 1988
• 资助国家: 美国
• 起止时间: 1988-09-30 至 1991-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3212283
• 关键词: AIDS; disease /disorder proneness /risk; drug abuse chemotherapy; drug addiction; employee; health care cost /financing; health care facility; health care service; human subject; human therapy evaluation; interview; intravenous drug abuse; longitudinal human study; mental health counseling; methadone; opiate alkaloid; social support network; urinalysis

Because of the emerging epidemic of AIDS and the still unchecked problems of opiate abuse, the need for an effective drug abuse treatment is even more important than in years past. For this reasons some have suggested elimination of a minimum counselor- patient ratio requirement (now 1 to 50) and the reduction in the number of urine specimens required by methadone maintenance programs (now 1 per month). With these liberalized criteria it is argued that more potential clients could be treated and in turn, the risks for continued drug use, crime, and AIDS could be reduced. In contrast, others have argued that the expanded use of methadone, particularly under loosely supervised conditions, could even have adverse effects on those in treatment. This project will test these important arguments in a prospective, random assignment evaluation of three different levels of methadone maintenance treatment provided over a six-month period: A) Minimum Methadone Maintenance (MMM) - Blocking doses of methadone, plus emergency counseling and referral services; but no regular counseling, no privilege contingencies based on urine results and no additional services such as family or employment counseling. B) Basic Methadon Maintenance (BMM) - Blocking doses of methadone, plus regular, supervised counseling and referral services using weekly urine screens as the basis for contingency management of the patient; but no extra services such as family or employment counseling. C) Enhanced Methadone Maintenance (EMM) - All the services described under BMM; plus extra medical/psychiatric care, social work assistance, family therapy and employment counseling designed to develop job-seeking and job-holding skills. These three interventions will be tested for efficacy and cost- effectiveness in two different methadone treatment program: 1) a hospital-based, medically managed program, 2) a stand-alone, non- medically managed, community program: and in two treatment samples: 1) newly admitted patients, 2) patients who have been in treatment for six months. Fifty patients from each of the two samples, will be randomly assigned to each of the three treatment interventions, in each of the treatment programs, for a total sample size of 600 patients over the three-year course of the project. All patients will be evaluated using a battery of instruments at the start of treatment, at 3 and 6-months during treatment, and at 6-month follow-up. Major outcome measures will include drug use, employment, crime, health care utilization, AIDS-related behaviors and the costs of care delivered to each patient during treatment.

由于艾滋病的流行和尚未得到控制 滥用鸦片剂问题，需要有效的药物滥用 治疗比过去几年更加重要。 为此 一些人建议取消最低辅导员的原因- 患者比例要求（现在为1比50）以及 美沙酮维持治疗所需的尿液样本数目 计划（现在每月1个）。 有了这些自由化的标准， 认为可以治疗更多的潜在客户，反过来， 继续吸毒、犯罪和艾滋病的风险可以降低。 相反，其他人则认为，美沙酮的广泛使用， 尤其是在监管不严的情况下， 对正在接受治疗的人有不良影响。 这个项目将在未来测试这些重要的论点， 三种不同剂量美沙酮的随机分配评价 在6个月期间提供维持治疗： A）最低美沙酮维持量（MMM）-阻断剂量 美沙酮，加上紧急咨询和转介服务;但没有 定期咨询，不能因为尿就有特权 没有额外的服务，如家庭或就业 辅导 B）基础美沙酮维持（BMM）-美沙酮的阻断剂量， 再加上定期的，监督咨询和转介服务， 每周尿液筛查作为应急管理的基础 病人;但没有额外的服务，如家庭或就业 辅导 C）强化美沙酮维持治疗-所有服务 在BMM下描述;加上额外的医疗/精神病护理，社会 工作援助、家庭治疗和就业咨询， 发展求职和就业技能。 这三种干预措施将进行有效性和成本测试- 两种不同美沙酮治疗计划成效：1）a 以医院为基础，医疗管理的计划，2）一个独立的，非 医疗管理，社区计划：并在两个治疗 样本：1）新入院的患者，2）已 治疗了六个月。 将从两个样本中的每一个中随机抽取50名患者， 分配给三种治疗干预措施中的每一种， 治疗方案，总样本量为600例患者 在这个项目的三年过程中。 所有患者将被 在治疗开始时使用一组仪器进行评估， 治疗期间3个月和6个月以及6个月随访时。 主要的成果指标将包括毒品使用、就业、犯罪、 卫生保健利用，艾滋病相关行为和费用 在治疗过程中为每位患者提供护理。