美沙酮维持治疗外带服务的探索与实践

Exploration of take-home methadone service in a methadone maintenance treatment program

目的探索实施美沙酮维持治疗外带服务的适宜性及可操作性,为优化现有美沙酮维持治疗服务工作提供科学依据。方法招募符合条件的维持治疗患者,实施分级管理的美沙酮外带服务,持续尿检监测外带服务期间毒品使用情况,并研究分析其相关因素。结果 2015年3月至2016年4月,共计51名患者参与研究,男女性别比为2.64∶1,>45岁者占51.0%(26人);小学及初中文化者占72.5%(37人);吸毒年限15年以上者占74.5%(38人);45例(88.2%)曾经有戒毒经历。外带服务期间尿检阳性率为1.24%(12/967),有12例(23.5%)因尿检阳性或不配合尿检而终止外带服务。管理水平较好的门诊中,研究对象退出美沙酮外带服务的比例相对较低(12.1%VS 44.4%,P<0.001)。结论实施美沙酮外带服务时需要尽可能充分发挥其有利方面,并消除弊端的风险,使参与外带服务的患者能从中受益,并提高门诊维持治疗的质量和水平;在外带服务实施过程中,门诊需要增加心理咨询、行为矫治等综合干预措施以提升外带服务效果。

Objective To explore the feasibility and practicability of take-home methadone service in methadone maintenance treatment（MMT）,and to provide evidences for improving MMT program.Methods Patients who met the enrollment criteria were recruited to receive hierarchical take-home methadone services.Urinalysis testing for opiate use was implemented and the associated factors were analyzed. Results A total of 51 patients enrolled in our study from Mar 2015 to Apr 2016,and the male to female ratio was 2.64：1.51.0%（26/51）aged ≥45years and72.5%（37/51）had primary school education or junior middle school education level.74.5%（38/51）had more than15 years of drug use and 88.2%（45/51）had drug rehabilitation experience.The positive rate of urinalysis was 1.24（12/967）,and 23.5 %（12cases）were terminated from take-home service for positive urine test result or missing scheduled urinalysis.Patients in clinic A with better administration have lower rate of cancellation from take-home service than clinic B（12.1% VS 44.4%,P〈0.001）. Conclusion The implementation of take-home service should be based on the evidences of advantages and risks to make more MMT patients benefit from it,and comprehensive psycho-social measures including psychological counseling and behavioral intervention should be conducted to improve the effectiveness of take-home service program.