乌鲁木齐市吸毒者社区美沙酮维持治疗保持情况及其影响因素分析

Factors associated with retention in a community-based methadone maintenance treatment among drug users in Urumqi, Xinjlang Uigur Autonomous Region

目的初步了解乌鲁木齐市吸毒者社区美沙酮维持治疗的保持情况及其影响因素。方法在新疆维吾尔自治区精神卫生中心社区美沙酮维持治疗门诊点，调查参加维持治疗的吸毒者的社会人口学和本底吸毒行为，以及美沙酮维持治疗情况。结果截至2006年2月10日，接受美沙酮维持治疗的709名吸毒者进入美沙酮维持治疗的时间中位数为77d，有353人退出治疗。服用首剂美沙酮后达90d和180d的累积脱失率分别为73．8％（336／455）和99．4％（353／355）。美沙酮维持治疗脱失发生率为29．8／100人月，在美沙酮维持治疗项目中保持时间的中位数为68．0d（95％CI：59．0～78．0）。在多因素Cox比例风险回归模型分析中，维吾尔族（HR值为1．35；95％CI：1．09～1．67）、吸毒年限长（HR值为0．74；95％CI：0．55～0．99）和稳定剂量高（HR值为0．60；95％CI：0．48～0．74）与美沙酮维持治疗脱失的关系有统计学意义。结论调查结果提示乌鲁木齐市吸毒者社区美沙酮维持治疗保持率低。需要对吸毒者尤其是维吾尔族吸毒者加强心理辅导和根据个体情况适当调高美沙酮剂量来提高该人群美沙酮维持治疗的依从性。

Objective To explore the factors associated with retention in a community-based methadone maintenance treatment（MMT） among drug users in Urumqi. Methods With national MMT guideline（ drift ） for heroine addicted drug users, local heroine-dependent people were admitted to community-based MMT program affiliated to Xinjiang Uigur Autonomous Region Center for Mental Health. Data on outpatients＇ social-demo characteristics, baseline behaviors on drug use and daily stabilized dose of drugs were entered to MMT database. Results Up to 10 ,Feb. ,2006,353 persons withdrew MMT treatment among 709 heroin dependant drug users. Between 11, Aug., 2005 and 10, Feb., 2006, with median duration as 77 days,cumulative drop-out rate of 90 days and 180 days after first dose of MMT were 73.8 % among 455 and 99.4 % among 355 drug users, respectively. The incidence of drop-outs was 29.8 per 100 person-month. The median length of stay （days） in MMT was 68.0 （ 95 % CI ： 59.0- 78.0 ）. Correlates of retention were found as： Being Uigur（ HR = 1. 35 ; 95 % CI ： 1. 09-1.67）, duration of drug use （HR =0.74;95% CI：0.55-0.99） and stabilized dose（HR = 0.60;95% CI：0.48-0.74） was found in multiple Cox proportional hazard regression model, Conclusion Retention of MMT among drug users in Urumqi was low. Uigur people should be given individual counseling to help them increase the compliance rate. Within the ranges of clinic dosage, adjustment of the methadone dose on an individual base might serve as an appropriate approach to increase the effectiveness of the program.