上海地区美沙酮维持治疗患者脱失原因调查

目的:了解上海地区美沙酮维持治疗(MMT)的脱失原因,为进一步推动MMT的健康发展及制定相关的政策提供依据。方法:采用定量、定性相结合的调查方法,对参加MMT的脱失人员进行调查。结果:上海市5个MMT门诊点共脱失401例,占参加治疗总人数的34·5%(401/1161)。脱失者中男性占76·8%,女性占23·2%;30a以上占87·2%;无业闲散人员占87·0%;初中及以下者占65·3%;既往吸毒时间在6-15a者占76·6%;静脉注射占63·3%;曾强戒和劳教戒毒者占85·6%;65·6%的人在治疗的3个月之内脱失;脱失时72·4%的人美沙酮维持剂量在60mg以下。脱失的主要原因:复吸、贩毒、盗窃、吸食冰毒等被强戒、劳教或被公安机关打击,占38·9%;自愿退出、缺席15d以上和不明原因占30·2%;离开上海、转出或工作占21·9%;躯体疾病或死亡占6·9%。访谈了解到:复吸的原因主要是:(1)受原吸毒环境和吸毒人员的影响、引诱或怂恿而偷吸海洛因(俗称"沾酱油");(2)摆脱不了对毒品的心理依赖,或对美沙酮的药效作用存在不正确的认知;(3)美沙酮服药剂量偏小。而对美沙酮及其维持治疗存在不正确的认知;家庭经济困难、服药用资金得不到保障;门诊时间与工作时间冲突,路途远和公安机关因全员收戒吸毒者、打击力度大,害怕打击与脱失有关。结论:脱失多发生在治疗的早期;脱失的原因很多,但复吸是重要原因之一。作者针对上述原因提出了相应的建议。

SURVEY ON REASONS FOR DROP OUT OF METHADONE MAINTENANCE TREATMENT IN SHANGHAI

Objective:To understand the reasons for drop out of methadone maintenance treatment (MMT) in Shanghai and provide scientific data for healthy development of MMT. Methods:A quantitative and qualitative survey was carried out in the drop out population of MMT and the staff of MMT clinics. Results:Altogether 401 cases had the experience of drop out from MMT, accounting for 34.5% of the total number on MMT (401/1161). Among them, male accounted for 76.8%,while female 23.2%;87.2% were more than 30 years old;87.0% had no job; 65.3% had middle school or lower education;76.6% had 6-15 year drug abuse history;63.3% were IDUS;85.6% underwent compulsory detoxification or rehabilitation through labor;65.6% dropped out within three months on MMT; 72.4% were on MMT with the dosage under 60 mg at drop out. The main reasons for drop out were: returned to compulsory treatment, or rested because of urine drug positive(use drugs again), drug dealing, rap and rend(38.9%); voluntarily left or left without reason, absent for 15 days(30.2%); left Shanghai, or being employed or referred(21.9%); ill or dead(6.9%). Interview showed that the main reasons for using drugs again were:(1) old environment, drug user peers alluring and inciting (use drug as sauce for methadone); (2) psychological dependence on drugs, misunderstood of the effect of methadone;(3) low dose of methadone taken. And the following were related with drop out: incorrect knowledge of methadone and MMT, difficulty in domestic economy, lack of money for MMT, conflict between open hour of MMT clinic and work hour, long travel from home to clinic, policy and action on detoxification from local public security agencies. Conclusion:Drop out generally happens during the first three months on MMT. Reasons for drop out are various with relapse as the most important one. We discussed the reasons and made some suggestions accordingly.