中国九城市1301名社区美沙酮维持治疗门诊患者偷吸海洛因及影响因素分析

目的 了解社区美沙酮维持治疗患者治疗期间偷吸海洛因的情况及其影响因素.方法 在江苏、安徽、云南3省9个城市社区美沙酮维持治疗门诊中抽取1301名符合条件的患者进行问卷调查与随机尿吗啡定性检测.收集一般人口学、艾滋病/毒品滥用相关高危行为、参加美沙酮维持治疗情况、抑郁与焦虑及偷吸海洛因等信息.结果 1301名调查对象中男性居多(76.2%),年龄(34.6±6.5)岁,受教育程度以初中及以下为主(71.7%).平均维持治疗剂量(48.1±29.4)mg/d,目前治疗剂量自我满意度平均得分为8.6,尿吗啡检测阳性率为27.7%.有抑郁和焦虑症状者比例分别为38.3%和18.4%,抑郁合并焦虑症状的比例为14.2%.婚姻状况、治疗时间的长短、目前治疗剂量自我满意度及是否曾退出治疗对偷吸海洛因影响的差异有统计学意义,而性别、教育程度及治疗剂量对偷吸海洛因的影响差异无统计学意义.不同省份间影响偷吸海洛因的因素有所不同,但对当前剂量自我满意度是共同的影响因素.结论 提高门诊服务质量及服药依从性、延长参加治疗的时间、提高患者对治疗剂量的满意度及避免脱失对减少治疗期间偷吸海洛因有重要意义.

Risk factors which were associated with heroin use during the methadone maintenancetreatment among 1301 patients in 9 cities of China

Objective To determine the proportion of heroin use among patients who were involved in community-based methadone maintenance treatment (MMT) program and to identify the risk factors associated with heroin use. Methods This study was conducted in 9 MMT clinics within 3 provinces. Thirteen hundred and one patients who met the study criteria were selected from each of the five groups with different dosages of methadone users. An administrative questionnaire was applied to explore the demographics,drug abuse-related behaviors and MMT services received by the clients,etc. The prevalence of depression and anxiety among the clients were also collected by SAS and SDS. Urine samples were collected as a biological marker to indicate if heroin had been used. Results Of the 1301 patients,76.2% were males. The mean age was (34.6±6.5) years while 71.7% had an education level of primary school or below. The average daily dosage of methadone was (48.1±29.4) mg and self-satisfied evaluation score on treatment was 8.6. On average,27.7% urine samples showed positive opiate evidence. Marital status,employment status,treatment retention,self-satisfied evaluation score on dosage and dropout history were found to be significantly associatedwith heroin use,while gender,education level and dosage had no significant association with heroin use. It seemed that risk factors that associated with heroin use were different from areas to areas. Conclusion High quality MMT clinic services,high self-satisfied score,longer treatment retention and low dropout rate seemed to have the effects of reducing the risk of ongoing heroin abuse under the methadone maintenance treatment program.