海洛因成癮患者接受美沙冬替代療法三個月後留存在治療中與海洛因使用量變化的相關因素

Abstract

目的：本研究主要目的有二，一、探討參加美沙冬療法三個月後，個案退出的相關因素。二、探討參加美沙冬療法三個月後，個案海洛因使用減少量的相關因素。 方法：本研究為世代研究法。資料來源為筆者所參與執行之國立台灣大學醫療機構管理研究所楊銘欽副教授主持的管制藥品管理局九十八年度委託科技研究計畫，以台灣北中南五家美沙冬服務量較大的醫院為參與研究機構，收案對象為從未參與美沙冬治療或者曾經參加但是已退出超過半年者。在民國98年6月至9月收案，總共有333位。前測包含收集基本資料，施予鴉片治療指數量表的問卷。於民國98年9月至12月針對前述個案，仍在治療中未退出的共127人，再度施予鴉片治療指數量表的後測。 結果：研究結果顯示，滿三個月時個案是否退出治療之相關因素，發現吸入使用海洛因的個案比針頭注射使用海洛因的個案，較容易退出治療。另外接受治療的醫院不同，與三個月後是否退出顯著相關。 其次，經過三個月的治療後，海洛因使用量，相對於初診進入治療前的減少量之相關因素包括：初診時海洛因使用量越大者，經過三個月後，海洛因使用減少量顯著較大。但初診時自覺健康狀況較佳者，每日海洛因使用減少量較小。 結論：對於海洛因使用量較大的個案，美沙冬所產生的減少海洛因使用量的效果卻更好。建議政策制定機關，應該提高誘因，使個案能繼續留在治療之中，則從個人、家庭到整個社會都將獲利。另外，在評估各醫療機構個案退出率作為品質指標時，個案使用海洛因不同途徑的比例組成也要考慮。最後，各醫療機構間在本研究的重要療效指標有顯著差異，建議可以彼此互相標竿學習，針對服務流程作改良，以增加個案的醫療可近性，以期降低退出率，並減少個案海洛因濫用的量。

OBJECTIVE: To determine factors associated with retention in treatment and change of daily amount of heroin abused in heroin-dependent patients receiving Methadone Maintenance Treatment for three months. METHODS: This is a prospective cohort study. Participants were from 5 hospitals with larger case numbers of Methadone Maintenance Treatment (MMT) in Taiwan. Participants were patients never received MMT before or had already dropped out from previous treatments for at least 6 months. Questionnaire including demographic data and Opiate Treatment Index (OTI) were distributed to 333 patients at the beginning of the treatment course from June to September 2009. Three months later, the OTI were re-interviewed for127 patients remained in the MMT for 3 months from September to December 2009. RESULTS: After 3 months, heroin use with smoking was associated with higher rates of discontinuing treatment compared with heroin use with injection. Dropout rates among hospitals were significantly different. More reduction in heroin use after 3-month treatment was associated with higher amount of heroin use when entering the treatment. Better self-perception of physical wellbeing at the beginning was associated with less reduction in heroin use 3 months later. CONCLUSION: Methadone has greater effect on reducing heroin use in patients abusing more amounts of heroin. The policy makers might encourage heroin-dependent patients to continue treatment and it will benefit those patients, their families and even the whole society. Since patients abusing heroin with different routes have significant difference in dropout rates, the diversity of patient composition among different hospitals should be considered in evaluating their performance with indicator of retention rates. There are differences of some effectiveness indicators among those hospitals participating in the study. Reviewing current service procedures and improving accessibility for those patients might help reducing dropout rates and finally the amounts of heroin use.