贵州省美沙酮维持治疗门诊海洛因成瘾者偷吸海洛因现状及其影响因素

Risk factors associated with continued heroin use during methadone maintenance treatment in Guizhou province, China

目的调查贵州省美沙酮维持治疗门诊海洛因成瘾者偷吸海洛因的情况及其影响因素。方法从贵州省的8个美沙酮门诊招募了1003名新人组的海洛因成瘾者，进行14个月随访。在随访期间对每个招募的海洛因成瘾者在不同的时间进行尿检。将美沙酮门诊、性别、婚姻情况、工作情况、民族、宗教信仰、使用海洛因的方法、是否强制戒毒过、年龄、美沙酮日平均服药剂量、受教育时间和使用毒品的年限作为自变量代入广义估计方程（GEE）进行分析。结果1003名海洛因成瘾者平均年龄为（33．3±6．1）岁，平均使用毒品的时间为（8．0±4．0）年，平均日美沙酮剂量为（38．0±16．6）mg。1003名海洛因成瘾者中女性成瘾者占26．0％；15．5％离异；35．8％有全职工作。在治疗不足10个月的海洛因成瘾者中尿检阳性率在30％左右，治疗超过10个月后尿检阳性率开始下降。美沙酮门诊、美沙酮日平均剂量（RR=0．98，P=0．003）、维持治疗时间（RR=0．95，P=0．029）和受教育时间（RR=0．94，P=0．014）是影响海洛因成瘾者偷吸海洛因的因素。结论在贵州省的8个美沙酮门诊受治者中偷吸海洛因现象比较普遍，应考虑提高美沙酮剂量和维持治疗时间以减少患者偷吸海洛因的情况。

Objective To investigate the proportion of methadone maintenance treatment （MMT） clients continuing to use heroin and to explore its associated risk factors. Methods All 1003 heroin addictive patients were recruited from eight MMT clinics in Guizhou province and followed up for 14 months. During the 14 months, each MMT client received random urine tests. MMT clinics, gender, marital status ,employment, ethnicity, religion, previous drug using method, having a history being in detoxification program, age, methadone dosage, education level and length of drug use were treated as potential predicting variables into the GEE model. Results The average age of the 1003 clients was （ 33.3 ± 6. 1 ） years old, the average length of drug use was （ 8.0 ± 4. 0 ） years, and the average daily methadone dosage was （ 38.0 ± 16.6） mg. Among the 1003 clients,26. 0% were female drug users,15.5% were divorced and 35. 8% had a full time job. The rate of positive urine samples was approximately 30% for the first 10 months of follow-up, after which the positive rate decreased. The model found that different MMT clinics, the average daily methadone dosage （ RR = 0. 98, P = 0. 003 ）, treatment duration （ RR = 0. 95, P = 0. 029 ） and years of education （ RR = 0. 94, P = 0. 014 ） were associated with patients positive urine test. Conclusion Continued heroin use was common in MMT clinics in Guizhou province; increasing the dosage of methadone and the duration in the treatment program might decrease the continued use of heroin among clients in MMT clinics.