江苏省美沙酮维持治疗者新型毒品滥用影响因素的病例对照研究

New psychoactive substances abuse among patients with access to methadone maintenance treatment in Jiangsu province： a case-control study

目的 探讨美沙酮维持治疗（MMT）者新型毒品滥用原因及影响因素。方法 采用1 ∶ 1配对病例对照研究设计。研究现场为江苏省新型毒品滥用情况较为严重的5个MMT门诊（南京市2个、无锡市2个、连云港市1个）。截止2017年5月，招募接受MMT≥6个月的新型毒品滥用者为病例组，按照1 ∶ 1配对原则选择对照组。利用问卷调查收集一般人口学特征、MMT治疗情况、家庭及社会支持情况、治疗期间毒品滥用情况等信息，尿液检测新型毒品，采用条件logistic回归模型等对新型毒品滥用可能的影响因素进行分析。结果 研究对象共212人（病例组与对照组各106人），研究对象年龄（45.17.2）岁，以男性（78.3%，166/212）、已婚或同居（48.6%，103/212）、无业（63.2%，134/212）为主。滥用的主要新型毒品中，苯二氮卓占62.3%（66/106）、甲基苯丙胺占39.6%（42/106），同时滥用≥2种毒品占8.5%（9/106）。多因素分析结果显示，最近6个月治疗过程中滥用阿片类毒品会增加新型毒品（OR=3.25，95% CI：1.35-7.79）、苯二氮卓（OR=3.25，95% CI：1.11-9.47）及甲基苯丙胺（OR=13.31，95% CI：1.12-158.01）滥用风险；家人提供MMT费用（OR=25.93，95% CI：1.81-371.15）会增加甲基苯丙胺滥用的风险；参加MMT≥9年则会使新型毒品（OR=0.03，95% CI：0.01-0.21）、苯二氮卓（OR=0.02，95% CI：0.00-0.36）及甲基苯丙胺（OR=0.02，95% CI：0.00-0.69）的滥用风险减少。结论 随着MMT时间增加，MMT者的新型毒品滥用减少。家庭及朋友的社会支持存在问题，会增加新型毒品滥用，且多集中于日常吗啡尿检阳性率较高的MMT者中。

Objective To explore the reasons and factors associated with new psychoactive substances abuse among patients with access to methadone maintenance treatment （MMT）. Methods A well-developed questionnaire and urine tests were used to collect information about demographic characteristics, condition of MMT and drug abuse, family and social support of MMT clients. A 1：1 matched case-control study was conducted, and conditional logistic regression model was used to identify factors associated with new psychoactive substances abuse. Results A total of 212 （106 pairs） clients receiving MMT were recruited, and most of them were males （78.3%, 166/212）, married or cohabitant （48.6%, 103/212） and unemployed （63.2%, 134/212）. The average age of the clients was （45.17.2） years. The main types of abused new psychoactive substances were benzodiazepine （62.3%, 66/106） and methamphetamine （39.6%, 42/106）. The proportion of abusing multi new psychoactive substances was 8.5% （9/106）. Results from multivariate conditional logistic regression analysis indicated that using opioid drug during the past 6 months of MMT treatment might increase the risk of abusing new psychoactive substances （OR=3.25, 95% CI：1.35-7.79）, benzodiazepine （OR=3.25, 95% CI：1.11-9.47） and methamphetamine （OR=13.31, 95% CI：1.12-158.01）. Moreover, MMT for more than 9 years reduced the risk of abuse of new psychoactive substances （OR=0.03, 95% CI：0.01-0.21）, benzodiazepine （OR=0.02, 95% CI：0.00-0.36） and methamphetamine （OR=0.02, 95% CI：0.00-0.69）. Conclusion Less new psychoactive substances abuse might be associated with longer duration of MMT treatment. And inappropriate support from family and friends might increase the risk of abusing new psychoactive substances in MMT clients, especially in clients who used opioid.