江苏省美沙酮门诊在治病人药物滥用情况分析

目的:调查美沙酮门诊在治病人海洛因偷吸和多药滥用情况,为美沙酮门诊药物滥用预防和干预工作提供基础数据支持。方法:随机抽取江苏省3个美沙酮社区药物维持治疗门诊点,每个门诊按美沙酮服药剂量分层抽取150例正在治疗的海洛因成瘾者,现场问卷调查病人一般情况和多药滥用情况,采集的病人尿液分别做5种滥用物质检测。结果:449例在治病人中8.5%(38例)的病人曾经退出过治疗,23.8%(107例)的病人自我报告最近1个月偷吸过海洛因。尿检显示美沙酮门诊治疗病人多药滥用比例达到36.3%(163例),尿检结果中吗啡阳性率最高,为23.4%(105例);安定类为15.4%(69例);苯丙胺类为9.4%(42例);吗啡、苯丙胺类和安定类尿检阳性病人中分别有80.0%(84例)、14.3%(6例)和52.2%(36例)主动报告使用相关物质。结论:美沙酮门诊病人中有多种药物滥用和偷吸海洛因现象;门诊发现新型毒品尤其是甲基苯丙胺使用者。建议门诊加强对维持病人偷吸毒品的危害教育。     

美沙酮维持治疗患者需求状况调查

目的:了解社区美沙酮维持治疗患者的需求状况,为制定应对对策,提高社区美沙酮维持治疗质量提出相应建议。方法:自制"受治者需求调查表",调查了北京市2009年参加社区美沙酮维持治疗的194例海洛因依赖者的需求状况。结果:64.6%的服药人员存在药物副反应和相关疾病的需求问题,49.5%的服药人员存在心理及精神需求问题,43.7%的服药人员存在家庭功能方面的需求问题,32.6%的服药人员存在社会功能方面的需求问题,32.9%的服药人员存在职业培训需求问题。结论:美沙酮门诊内的海洛因依赖者均不同程度地存在需求问题,必须开展多种综合干预,提高美沙酮维持治疗的维持效果。     

美沙酮社区药物维持治疗门诊实施激励机制5年对门诊的影响

目的:探讨在美沙酮社区药物维持治疗门诊对海洛因成瘾者实施激励机制对门诊的影响。方法:在美沙酮社区药物维持治疗门诊实施一整套激励措施,分析实施激励措施对门诊的影响。结果:实施激励机制后,门诊服药秩序明显好转,病人服药依从性提高。实施激励机制1a后病人服药率明显提高,与同期开诊的另外3家未实施激励机制的MMT门诊比较,其它3家门诊累计在治病人服药率仅为62.4%,而本门诊实施激励机制后,门诊服药率达到75.8%,服药率明显提高,具有显著统计学意义(P<0.01)。实施前治疗维持率88.9%,实施后治疗维持率达90.8%。实施激励机制对门诊管理带来正性影响,并且增加的支出在门诊可控范围内。结论:实施激励机制有利于提高患者参加维持治疗的依从性,提高治疗维持率及服药率。对于较长时间维持的服药者,激励机制对于促进患者坚持参加维持治疗,回归社会具有积极意义。     

上海美沙酮维持治疗门诊用药监测现状

目的了解上海美沙酮维持治疗门诊的用药监测现状,为监管提供合理化建议。方法收集2005―2012年上海市14家美沙酮维持治疗门诊纳入到药物滥用监测范围内的药物滥用者的资料,比对纳入国家药物滥用监测网络信息管理系统与中国疾病预防控制信息系统中的美沙酮维持治疗门诊数据,调查上海市美沙酮维持治疗门诊的药液损耗、药桶回收等情况,并访谈相关医生、药师。结果上海美沙酮维持治疗门诊累积上报《药物滥用监测调查表》数(7 100例),少于上报中国疾病预防控制信息系统数(8 905例),未报率达到20.27%,主要原因为临时转诊服药患者未纳入药物滥用监测范围。调查中发现美沙酮用药量记录有误,药液桶回收处理存在问题,美沙酮替代疗法使用后出现的不良反应未能进行有效监测。结论美沙酮维持治疗门诊的药物滥用监管中应加强《药物滥用监测调查表》的上报,加强不良反应监测和药液监管。     

社会支持对武汉市美沙酮维持治疗者依从性影响的调查研究

目的:了解武汉市美沙酮维持治疗者的社会支持状态,分析社会支持对美沙酮维持治疗者依从性的影响,为制定地区性综合防治措施提供一定的科学依据。方法:选取在武汉市3个主城区共5家美沙酮维持治疗门诊参加治疗的600名海洛因成瘾患者进行问卷调查,采用社会支持评估量表(SSRS)以及自制的美沙酮维持治疗患者一般情况调查表对患者的社会支持以及美沙酮维持治疗情况进行统计分析。结果:参与调查的患者中,年服药率75%以上组社会支持评分明显高于年服药率75%以下组;一年内尿检阳性次数0次组社会支持评分高于一年内尿检阳性次数0次以上组;一年内复吸次数0次组社会支持评分高于一年复吸次数0次以上组;女性组对社会支持的利用度高于男性组。结论:社会支持对于提高美沙酮维持治疗患者服药率、减少复吸、提高治疗依从性有非常积极的作用,应该加强美沙酮维持治疗患者的社会支持力度,提高治疗依从性,提高操守率,减少复吸。     

广州市新入组服药人员对美沙酮维持治疗认知情况的调查

目的：了解广州市美沙酮维持治疗（MMT）门诊新入组服药人员对美沙酮长期维持治疗的认知,为制定有针对性的干预措施以降低MMT服药人员脱失率提供参考依据。方法分别从白云等三个美沙酮维持治疗门诊的新入组治疗者中招募的符合研究要求的病例,共288例。采用自行设计的问卷对招募对象进行一对一面对面调查。结果新入组服药人员对MMT的期望较高,但认知存在一定误区。在MMT知晓上,除81.2%服用美沙酮期间同时吸毒会对身体造成很大损害外,93.0%认为美沙酮对身体有损害,治疗期间能少服还是尽量少服;91.2%认为美沙酮维持治疗是帮助他们戒毒;88.5%不认可需要长期甚至终身服用美沙酮;78.0%只回答正确五题中的一题或全部没有答对。结论MMT门诊应采取有针对干预措施,强化服务意识,加强对新入组服药人员的健康教育工作,普及美沙酮维持治疗知识,减少服药人员治疗脱失。     

2011-2015年我国美沙酮维持治疗人员吸毒过量死亡分析

目的:分析我国参加美沙酮维持治疗吸毒过量死亡人员基本情况和死亡时间分布,为制定降低死亡的措施提供依据。方法:收集2011-2015年全国美沙酮维持治疗门诊报告因吸毒过量死亡的治疗人员基本信息,参加治疗信息,分析死亡人员特点,死亡发生的时间,探讨不同治疗时段死亡的相关因素。结果:2011-2015年间,全国美沙酮维持治疗者累计报告因吸毒过量死亡408例,死亡时平均年龄38.3±7.4岁;第1-4周内死亡人数占总报告死亡人数的28.7%,前8周死亡人数占总报告死亡人数的38.7%;停止服药后4周内死亡人数占总报告死亡人数的54.9%;开始治疗或重新开始治疗4周内死亡人员治疗依从性低于4周以后死亡人员(t=2.63,P=0.009)。结论:参加美沙酮维持治疗人员吸毒过量死亡多发生在治疗(或中断治疗后再次治疗)初始阶段和停止服药后的初期阶段,应针对新参加治疗人员加强干预,对停止治疗人员及时随访,提高治疗依从性。     

117例美沙酮维持治疗情况分析

目的:了解美沙酮维持治疗的有效性及依从性。方法:采用自拟调查问卷对部分坚持治疗,且愿意回答问题的患者进行美沙酮维持治疗情况调查;对脱失情况进行描述性分析。结果:2005年6月-2006年6月共接受美沙酮维持治疗患者117例,其中脱失38例,占32.5%。脱失原因主要有:因吸食海洛因或违法犯罪等被公安强制戒毒或劳教、判刑等处理,占81.6%;累计超过15d未来门诊服药,被取消资格,占15.8%。67例坚持治疗者接受了问卷调查。调查结果显示,服药后100%的人恢复了正常生活;92.5%有复吸海洛因的欲望,但37.3%没有复吸行为发生;71.6%认为维持治疗的最佳剂量是40-59mg.d-1;62.7%认为应根据治疗者目前经济状况确定治疗价位。结论:美沙酮维持治疗效果明确,但仍存在一些问题;复吸和违法犯罪是主要的脱失原因。采取切实有效的干预措施有利于延长治疗时间,提高治疗效果。     

369例美沙酮门诊患者治疗依从性影响因素分析

目的:了解美沙酮维持治疗门诊中影响阿片类依赖患者治疗依从性的原因,以及依从性对其工作生活状态的影响。方法:自行设计问卷对369例接受美沙酮维持治疗患者的依从性、服药期间毒品使用情况、工作、家庭状态的改善情况以及造成中断治疗和复吸的原因进行调查。结果:依从性好和比较好的占39.57%;依从性差的为60.43%。停用毒品和使用毒品减少50%以上的有230例(62.33%);恢复正常工作或工作状态明显改善者188例(50.94%)、家庭关系恢复正常或明显改善者169例(45.80%)。恢复工作和生活的正常状态的程度均与治疗依从性显著相关。造成复吸最主要的社会因素为受到朋友(毒友或毒贩)诱惑(89.70%),回到原来的吸毒环境(88.08%)。结论:自愿进行门诊美沙酮维持治疗的吸毒人员具有良好依从性的比例低;治疗效果与依从性好坏明显相关;依从性的好坏与环境、躯体和心理因素等有关。美沙酮门诊治疗是阿片依赖患者进行脱毒治疗的有效方式之一,提高依从性是提高有效率的关键。     

美沙酮维持治疗依从性的调查分析

目的 了解美沙酮维持治疗的依从性.方法 采用基线和随访调查,对脱失情况进行描述性分析.结果 2007年12月至2009年2月共接受美沙酮维持治疗患者418例,其中脱失317例,占75.8%.脱失原因主要有:累计超过7天未来门诊服药,被取消资格,占81.7%;因吸食海洛因或违法犯罪等被公安部门强制戒毒或劳教、判刑等处理,占18.3%.结论 美沙酮维持治疗的脱失率非常高,如何提高美沙酮维持治疗的依从性,今后仍然是社会学和医学的一个课题.     

Health status of clients receiving methadone maintenance treatment using the SF-36 health survey questionnaire

This study investigated the health status of a representative sample of clients (35 Maori, 72 non-Maori) receiving methadone maintenance treatment in New Zealand, using the SF-36 health survey. The publication of New Zealand norms in 1999 enabled comparisons of the health of the Methadone Treatment Programme study participants with that of the New Zealand population. Although over 50% of participants rated their health as good, very good or excellent, 44% rated their health as fair or poor and compared with population norms, the health of the study participants was significantly poorer on all eight SF-36 scales. Male and female participants rated their health similarly to male and female clients attending another New Zealand Methadone Treatment Programme. Results highlighted the impact of a chronic disorder and co-existing health-related problems on the health and well-being and day-to-day functioning of this client group. Higher frequency of benzodiazepine use was associated with poorer social functioning, mental health and role functioning and higher frequency of cannabis use was associated with poorer role functioning due to emotional problems. Findings support routine monitoring of health status with clients receiving methadone maintenance treatment as a guide to preventative and treatment interventions and health maintenance strategies. [Deering DE, Frampton CMA, Horn J, Sellman JD, Adamson SJ, Potiki TL. Health status of clients receiving methadone maintenance treatment using the SF-36 health survey questionnaire. Drug Alcohol Rev 2004;23:273-280]     

Characteristics and 9-month outcomes of discharged methadone maintenance clients

This study is a secondary data analysis of a clinical trial assessing the effectiveness of outreach case management (OCM) in linking discharged methadone patients back into treatment. The original trial assessed the effectiveness of the OCM intervention compared to a passive referral among methadone clients who needed treatment postdischarge but had not reengaged. The purpose of this study was to assess the characteristics and long-term outcomes of all clients who were discharged from methadone maintenance treatment including those who had reengaged in treatment. A total of 230 methadone clients were interviewed 3 months and then again at 9 months following discharge from treatment. Compared with participants who needed treatment but had not reengaged (NoTx: 56%), those who had successfully reenrolled in treatment (Tx; 44%) were more likely to be female, not married, and unemployed; had a longer history of sedative use; reported more psychiatric hospitalizations; and were originally enrolled in a community-based rather than a Veterans Administration program. Despite having more severe problems, the Tx group had fewer opioid-positive urines and reported less IV drug use at 9 months postdischarge compared to the NoTx group. The findings highlight the importance of rapid treatment reengagement.     

Pharmacists' provision of methadone to intoxicated clients in community pharmacies, Victoria, Australia

This paper concerns pharmacists dispensing methadone to intoxicated clients, drawing on both questionnaire and focus-group data from a 1996 evaluation of the community-based methadone programme in Victoria, Australia. The questionnaire was sent to registered community methadone pharmacies in Victoria (N = 188). The response rate was 84% and 148 questionnaires were analysed. Pharmacists were asked how they would respond to clients who presented intoxicated for their methadone dose. Results indicated that 32% of pharmacists said that they would provide a client who presented intoxicated with his or her usual methadone dose. The analyses suggested that pharmacists who were male and those pharmacists whose number of methadone clients exceeded 10 were more likely to dispense methadone to an intoxicated client than female pharmacists and those pharmacists with less than 10 clients. Pharmacists who would withhold the methadone dose were more likely to inform the client's prescribing doctor at the time (74%) than pharmacists who would provide the usual or modified dose (41%). In order to understand the social processes underlying provision of methadone to intoxicated clients this theme was later taken up in a focus group with pharmacists. Reasons given by pharmacists to explain the dispensing of methadone to intoxicated clients were: insufficient communication between prescribers and pharmacists; a down playing of the pharmacological dangers; personal beliefs and values; a fear of retribution from the client if thedose was refused; difficulty in recognizing intoxication; lack of education and training. The results raise concerns about the basis on which pharmacists make decisions about providing methadone to intoxicated clients. [Koutroulis GY, Kutin JJ, Ugoni AM, Odgers P, Muhleisen P, Ezard N, Lintzeris N, Stowe A, Lanagan A. Pharmacists' provision of methadone to intoxicated clients in community pharmacies, Victoria, Australia. Drug Alcohol Rev 2000;19:299-308]     

Patients' help-seeking behaviours for health problems associated with methadone and buprenorphine treatment

Introduction and Aims . Clients in opioid substitution therapy often have considerable unmet health‐care needs. The current study aimed to explore health problems related to opioid substitution therapy among clients on methadone and buprenorphine treatment. Design and Methods . A self‐complete, cross‐sectional survey conducted among 508 patients receiving methadone and buprenorphine treatment at community pharmacies in New South Wales (NSW), Australia. Results . The most common problems for which participants had ever sought help were dental (29.9%), constipation (25.0%) and headache (24.0%). The most common problems for which participants would currently like help were dental (41.1%), sweating (26.4%) and reduced sexual enjoyment (24.2%). There were no significant differences between those currently on methadone and those currently on buprenorphine for any of the health problems explored, nor differences for gender or treatment duration. Participants on methadone doses 100 mg or above were significantly more likely to want help currently for sedation. Discussion and Conclusions . The considerable unmet health care needs among participants in this study suggest that treatment providers should consider improving the detection and response to common health problems related to opioid substitution therapy.     

Methadone maintenance treatment: outcomes from the Otago methadone programme

AIM: To provide information on methadone treatment outcomes for opiate-dependent individuals. METHODS: Questionnaires and random urine tests were completed for 112 Otago clients comparing outcomes before and during methadone maintenance treatment. RESULTS: Treatment retention rates were high, with 86% of clients remaining on the programme six months or more. The number of clients on benefits reduced by almost 30% during treatment, with employment rates doubling from 19% to 40% (including attendance at educational programmes). For the 89 clients injecting opiates daily at initial presentation, 64% reported no opiate use in the three months prior to review. Of the remaining 36%, opiate use reduced significantly. Rates of sharing injecting equipment reduced by almost 90%. Almost 50% of cannabis users reduced their use from daily to less than daily use. Clients reporting no current use of illicit benzodiazepines increased by 85%. Heavy binge drinking weekly or more reduced by almost 75%. Use of other illicit drugs reduced by almost 90%. Drug-related convictions reduced by almost 60%, while accidental drug overdoses reduced by over 90%. CONCLUSION: The widespread benefits of methadone maintenance treatment demonstrated underline the importance of making quality methadone programmes readily accessible within the health system. Currently, there are long waiting lists and many individuals cannot gain access to active treatment. We believe the health system urgently needs to look at expanding existing services and/or establishing private methadone clinics similar to those in New South Wales.     

Valium Use and Abuse by Methadone Maintenance Clients

Twenty-one Valium-using/abusing methadone maintenance clients were compared with 42 non-Valium-using clients as to demographic characteristics and two psychological indices, the Symptom Check List-90-R and the Addiction Severity Index. The Valium users scored much like adult psychiatric outpatients and had more drug and psychiatric problems than the Valium nonusers, who resembled most nearly “adolescent nonpatients” in profiles. Possible reasons for Valium use/abuse by methadone maintenance clients are discussed.     

Change and stability of change after treatment of drug misuse: 2-year outcomes from the National Treatment Outcome Research Study (UK)

The National Treatment Outcome Research Study (NTORS) is a longitudinal, multisite, prospective cohort study that assesses changes in illicit drug use and other problems after treatment in national (UK) drug misuse treatment programmes. Clients were recruited from 54 residential and community-based drug treatment programmes throughout England. Four modalities were studied: inpatient drug dependence units, residential/rehabilitation programmes, methadone maintenance, and methadone reduction programmes. Data on substance use behaviours and physical and psychological health were collected by structured face-to-face interviews at intake, 1- and 2-year follow-up. Data are presented for 549 clients. A majority of clients achieved widespread improvements across a range of outcome measures after treatment in existing treatment services. For most outcomes, reductions in problem behaviours at the group level occurred within the first year and were maintained at 2 years. Considerable stability of outcomes at the individual level was also found. Abstinence from illicit drugs was substantially increased among clients from both residential and community programmes, and there were also substantial reductions in frequency of use of heroin, nonprescribed methadone, benzodiazepines, and crack cocaine. Injecting and shared use of injecting equipment was also reduced. Heavy drinking was common at intake and was not reduced at follow-up. Psychological and physical health problems were reduced on both groups at follow-up. These changes represent important clinical benefits to the individual clients, to their families, and to society.     

Tapering from methadone maintenance: Attitudes of clients and staff

To investigate the barriers to tapering from methadone and to generate ideas for clinical services, 60 clients on methadone maintenance and 30 staff members in five methadone maintenance clinics were interviewed. The interview format combined quantitative and qualitative response options and assessed subjects' experience with tapering from methadone, ideas about barriers to tapering, suggestions about services that would aid them in getting off methadone, and aftercare services that would help them to remain drug-free. Both staff and patients noted significant barriers to methadone detoxification, estimating the likehood of completing a successful taper at 10% and 14%, respectively. Patients reported psychological symptoms of withdrawal discomfort, but they emphasized physical problems of withdrawal much more than did staff. Both groups noted the need for counseling, role models of detoxified former addicts, and a wide array of available services.     

Supplementary methadone self administration among methadone maintenance clients.

The present study derives from two related questions: (1) Can methadone dose alterations act as reinforcers? (2) Do methadone dose alterations affect symptomatology of methadone maintained clients? Twenty three clients were offered six opportunities to alter their own methadone dose on a single day by as much as ±20 mg. Dose increases were selected on the vast majority of occasions (94.3%). Thus, supplemental methadone did function as a reinforcer for these clients. There was little evidence that dose increases which clients chose had any appreciable subjective effects. Neither symptomatology self reports nor judgements of dosage adequacy were significantly altered following acute methadone dose increases.The amount of supplemental methadone which clients self-administered could not be predicted by demographic characteristics, by length of time enrolled in maintenance treatment, by type or amount of illicit supplementary drug use, or by adequacy judgements of stable methadone dose. However, dosage self-regulation may have predictive potential as a measure of degree of behavioral dependence on narcotic drugs.     

Changes in the characteristics of clients admitted to an Australian therapeutic community, "The Buttery", 1980-92

Data are presented on the characteristics of clients admitted to an Australian therapeutic community, The Buttery, between 1980 and 1992. The typical client was a 28-year-old male with a primary opioid drug problem complicated by polydrug use, particularly of alcohol and stimulants. Prior treatment experience was common, with one in three having been enrolled in methadone maintenance treatment. The average age of clients increased by about 7 months per year, and there was an increase in the prevalence of alcohol, stimulant and polydrug problems over the period of study. There was also an increase in the exposure of clients to methadone maintenance treatment prior to admission to the Buttery. Overall, the characteristics of patients in this drug-free treatment programme were strikingly similar to those observed among patients in methadone maintenance treatment over the same period.