桃園縣愛滋減害計畫中美沙冬替代療法之成效

Abstract

背景：我國推動美沙冬替代療法緣自於2004年迅速上升的藥癮愛滋疫情，自2006年美沙冬替代療法開始推行，未見美沙冬替代療法之成效評估。 目的：統計2006年至2010年桃園地區藥癮者參與美沙冬替代療法的情形。評估美沙冬替代療法的成效，包括：愛滋疫情、治安情形、就業情形。在接受美沙冬替代療法期間，分析參加者對美沙冬替代療法支持情形、戒癮信心變化，及其影響因素。 方法：對行政院衛生署疾病管制局法定傳染病通報系統及替代療法之個案通報系統作二級資料分析。另於桃園縣接受美沙冬替代療法之海洛因藥癮者進行問卷調查。 結果：自2006年辦計愛滋減害試畫，桃園地區接受美沙冬替代療法人數便迅速成長，2008年後達到高峰，然後是平坦及些微起伏。2008年服藥人數每日約1,700人，即21.6-27.4％海洛因使用者接受美沙冬替代療法。平均服藥出席率為63.9±6.2％。 在愛滋疫情方面，可看到藥癮愛滋感染者迅速下降。2006年，新增藥癮愛滋感染者降至214人，佔當年所有新增感染者之71.6％。2007年新增藥癮愛滋感染者降至89人，佔當年所有新增感染者之53％。2008年新增藥癮愛滋感染者降至28人，佔當年所有新增感染者之21.1％。2009年新增愛滋感染者 22人，佔當年所有新增感染者之16.5％；至2010年，新增藥癮愛滋感染者有12人，僅佔所有新增感染者之6.8％。另8位美沙冬替代療法個案，於治療期間出現愛滋病毒血清檢查由陰性轉為陽性（陽轉率0.2％）。 同樣地，可看到犯罪率在下降。桃園地區在2005年犯罪率為每10萬人口2,387件， 2009年降至每10萬人口812件。自2007年起查獲一級毒品案件數逐年下降，2005年至2010年查獲一級毒品案件數分別為2,519件、2,633件、2,488件、2,411件、2,230件、1,868件。 問卷部分，扣除填寫不完整問卷後共回收1,201份(98.0%)。2006-2009年間有固定收入者及固定職業的比例有增加的趨勢，且達統計顯著意義。對美沙冬替代療法的支持整體分數為43.4±6.0至44.0±6.0分，認為美沙冬替代療法對社會助益的面向分數最高，對個人助益的面向次之，疑慮的面向最低。在四個時間點總分及單題均沒有統計差異。性別和教育程度對美沙冬替代療法的支持達統計顯著意義。 美沙冬使用者的戒癮信心整體分數為27.4±4.8至28.1±4.6分，在四個時間總分及單題均沒有統計差異。性別、教育程度、是否為愛滋病毒感染者對戒癮信心分數達統計顯著意義。 結論：美沙冬替代療法在愛滋疫情控制、治安的改善及藥癮者的就業有助益。但是，未看到藥癮者在接受美沙冬替代療法期間的支持態度及戒癮信心有明顯變化。性別、教育程度是美沙冬替代療法支持態度的重要影響因素。而性別、教育程度、是否為愛滋病毒感染者是戒癮信心的重要影響因素。

Background: Due to an AIDS outbreak among Taiwanese injecting drug users (IDUs) in 2004, a methadone maintenance treatment (MMT) program for AIDS harm reduction was implemented in2006. However, there have been limited studies examining the impact of the MMT program. Aims: (1) To describe the number and rate of drug users participating in the MMT program from 2006 to 2010, (2) To examine the impact of MMT program including the AIDS epidemic and crime rate at the county level, and the employment at the individual level, and (3) To examine the MMT participants’ supportive attitudes towards the program and their self confidence in abstinence from the drugs, and factors associated with these two psychological variables. Methods: Secondary data analysis was conducted by using data from the reporting disease system and MMT program, Centers for Disease Control (CDC), Taiwan. A questionnaire survey was carried out among MMT participants in Taoyuan county. Results: Since 2006 when the AIDS harm reduction program began, the number of MMTparticipants increased sharply, reaching a peak in 2008, and remained stable with only slight fluctuation. After 2008, on average there were 1700 drug users participating in the MMT program daily, corresponding to a 21.6-27.4% of heroin users. The mean attendance rate in the MMT program was 63.9±6.2％. For the AIDS epidemic, the proportion of IDUs among HIV/AIDS cases declined substantially. Among incident cases of HIV/AIDS, there were 214 IDUs (71.6%) in 2006, 89 (53%) in 2007, 28 (21.1%) in 2008, 22 (16.5%) in 2009, and 22 (6.8%) in 2010. There were only 8 (0.2%) MMT participants who became HIV positive from 2006 to 2010. Similarly, a decrease in the crime rate was observed. In 2005, the crime rate in Taoyuan was 2387 per 100,000 people, but it declined to 812 per 100,000 by 2010. The number of arrests involving level I illicit drugs declined as well since 2007. From 2005 to 2010, there were 2519, 2633, 2488, 2411, 2230, and 1868 people, respectively, arrested due to owning, carrying, or using level I drugs. Regarding the questionnaire survey, 1201 questionnaires (98.0%) were completed. The rate of being employed or having a fixed income increased significantly from 2006 to 2009. The mean scores of positive attitudes supporting the MMT program were between 43.4±6.0 and 44.0±6.0. Among the three subscales of positive attitudes supporting the MMT program, advantages to society rated the highest, followed by advantages to IDUs, and doubt/worry rated the lowest. No obvious change in positive attitudes supporting MMT program was observed from 2006 to 2009. Gender and education were two factors that were significantly associated with positive attitudes supporting MMT program. Similarly, there was no obvious change in the mean scores of confidence of abstinence from drugs from2006 and 2009. The mean scores of confidence of abstinence from drugs were between 27.4±4.8and 28.1±4. Gender, education and HIV status were three factors significantly associated with the score of confidence of abstinence from drugs. Conclusions: The MMT program has had a positive impact on reduction of the AIDS epidemic, reduction of the crime rate, and improvement of employment for drug users. However, there was no change in positive attitudes supporting the MMT program and confidence of abstinence from drugs. Gender and education were two factors that were significantly associated with positive attitudes supporting the MMT program. Gender, education and HIV status were three factors that were significantly associated with the score of confidence of abstinence from drugs.