上海市美沙酮维持治疗门诊就诊者毒品滥用及其影响因素

 目的  了解上海市美沙酮维持治疗(methadone maintenance treatment, MMT)门诊服药对象毒品使用情况, 并分析其影响因素。方法  采用横断面研究设计,在上海市14个MMT门诊选取1 960名符合条件的服药人员进行问卷调查,收集社会人口学、药物滥用行为、维持治疗情况等相关信息,并开展五合一尿液毒品［吗啡、甲基苯丙胺(冰毒)、大麻、亚甲基二氧基甲基苯丙胺(摇头丸)、氯胺酮(K粉)］检测。结果  1 960名调查对象平均年龄(49.3±8.7)岁,平均吸食毒品(19.0±6.0)年,23.3%既往吸食过新型毒品,7.1%过去1个月有报告发生过吸毒行为。尿液检测结果:吗啡阳性率9.1%,冰毒阳性率3.7%,K粉阳性率0.1%,摇头丸阳性率0.3%,大麻阳性率0.2%。Logistic多因素回归分析结果显示:拒绝使用朋友提供的新型毒品的对象其吗啡滥用(OR=0.23, 95%CI: 0.14～0.39)与新型毒品滥用(OR=0.08, 95%CI: 0.05～0.15)风险均较低;与吸毒朋友没有交往(OR=0.59, 95%CI: 0.40～0.87)、治疗期间未发生脱失(OR=0.44,95%CI:0.30～0.64)的MMT服药对象吗啡滥用的风险较低;家庭关系一般较关系良好(OR=2.40, 95%CI: 1.17~4.92)、每天服药剂量40～59 mL较0～39 mL的(OR=1.96, 95%CI: 1.05～3.65)服药对象滥用吗啡风险增加;与参加MMT治疗3年以下的服药对象相比,参加MMT 4~6年的服药对象滥用吗啡风险(OR=0.51, 95%CI: 0.31~0.82)与滥用新型毒品风险(OR=0.41, 95%CI: 0.17～0.97)均较低。 结论  MMT门诊服药人员中存在滥用吗啡和其他新型毒品的现象,与吸毒朋友交往情况、家人关系、脱失及维持治疗时间有关联。应针对关键影响因素,对MMT服药对象有针对性地开展宣传教育和行为干预,减少毒品滥用的发生。

Drug abuse and related factors among methadone maintenance treatment objects in Shanghai

Objective  To investigate the proportion of drug abuse of methadone maintenance treatment (MMT) objects and to identify its related factors. Methods  A total of 1 960 MMT objects in 14 MMT clinics in Shanghai were recruited to participate in a cross-section study. Questionnaire including demographic information, drug abuse and MMT information were surveyed. Urine sample was collected to conduct multi-drug test as a biological marker to identify morphine, methamphetamine (crystal meth), marijuane, methylenedioxy methamphetamine (ecstasy), and ketamine (specieal K) abuse. Results  The average age of the 1 960 objects was (49.3±8.7) years old. The average duration of drug abuse was (19.0±6.0) years. About 23.3% of all the objects self-reported they had used club drug before, and 7.1% had abused drug in the past one month. Urine test showed that among the 1 960 objects, 9.1% had abused morphine, 3.7% had abused methamphetamine, 0.1% had abused ketamine, 0.3% had abused ecstasy and 0.2% had abused marijuana. Multiple logistic regression analysis showed that group of negative attitude towards club drug offered by friends had lower risk of abusing morphine (OR=0.23, 95%CI: 0.14-0.39) and club drug (OR=0.08, 95%CI: 0.05-0.15). The group of no contacts with drug abuse companion (OR=0.59, 95%CI: 0.40-0.87) and not having dropped out during MMT (OR=0.44, 95%CI: 0.30-0.64) had lower risk of abusing morphine. Compared with group of having good relationship with family and having daily methadone dose of 0-39 mL, the group of having ordinary relationship with family (OR=2.40, 95%CI: 1.17-4.92) and having daily methadone dose of 40-59 mL (OR=1.96, 95%CI: 1.05-3.65) had higher risk of abusing morphine. Compared with group of attending MMT for less than 3 years, the group of attending MMT for 4-6 years had lower risk of abusing morphine (OR=0.51, 95%CI: 0.31-0.82) and club drug (OR=0.41, 95%CI: 0.17-0.97). Conclusions  Drug abuse of  morphine and club drug were common during MMT clinics in Shanghai, and is related with the family, contacts with drug abuse companion, drop out during MMT, and years eurolled in MMT. Pertinence publicity and behavioural intervention should be undertaken to reduce drug abuse in MMT objects.