接受美沙冬療法者再使用海洛因行為之相關因素研究--以臺灣北區海洛因使用者為例

Relationship between Methadone Therapy and Heroin Relapse — a Case Study on Heroin Users in Northern Taiwan

王佩瑾(Pei-Chin Wang)

指導教授 ： 李思賢

國立臺灣師範大學/教育學院/健康促進與衛生教育學系在職進修碩士班/碩士(2012年)

摘要

本論文之研究目的在於瞭解臺灣北部4個地區美沙冬療法的海洛因使用者之社會人口學變項、生理臨床變項、美沙冬療法之知識、海洛因渴求量表之態度與再施用海洛因行為的情形及關係。本研究採用二級資料，該資料於2008年開始進行，立意選取研究個案共599位，所需資料採取半結構式問卷，經由美沙冬療法個案管理師一對一方式訪談填寫問卷，也藉由門診的醫療系統蒐集個案臨床資料。所得資料採用描述性統計、卡方檢定、點二系列相關及二元羅吉斯迴歸進行資料處理分析，歸納本研究結果，主要研究發現如下：
一、研究對象以男性 (87.0%)最多，教育程度以國中學歷 (50.2%)最多，年齡分佈以31-40歲 (41.7%)最多，初次使用海洛因年紀以21-30歲 (45.7%)最多。本研究對象中，愛滋病毒帶原陽性12.4%（71人）；C肝病毒帶原陽性93.1% (514人)；尿液篩檢嗎啡陽性67.4%（382人67.4%)，收案時美沙冬使用劑量平均為38.88 mg/day。
二、研究對象對美沙冬療法之知識，整體美沙冬知識題答對的比例偏高，顯示研究對象在美沙冬的知識屬正確居多。
三、研究對象海洛因渴求量度於各向度題目之分佈，大部分位於『同意』，顯示研究對象渴求量表具中度至高度的渴求向度，顯示研究對象仍有中高度的渴求海洛因行為。
四、研究對象對的美沙冬知識與渴求態度彼此間的相關皆呈現正相關，顯示研究對象對美沙冬知識的得分越高者，其渴求態度的得分也越高。
五、研究對象未再使用海洛因行為佔65.4%（242人），有再使用海洛因行為佔34.6%（128人）。
六、HIV篩檢結果，與海洛因再使用行為沒有顯著差異。C肝篩檢結果與海洛因再使用行為有顯著差異。
七、與再使用海洛因行為之羅吉斯迴歸分析結果，達統計顯著的變項為『最近一次C肝檢驗結果』、『年齡』、『初次使用海洛因年齡』、『最近一次使用美沙冬劑量』與『渴求態度—強迫行為』。

關鍵字

美沙冬療法 ； 美沙冬知識 ； 海洛因渴求 ； 海洛因成癮

並列摘要

The purpose of this thesis is to understand the condition and correlation between the socio-demographic variables, clinical physiological variables, knowledge of methadone therapy, intensity of heroin craving, and heroin relapse for four heroin users undertaking methadone therapy in Northern Taiwan. This study uses secondary data that have been collected since 2008. Five hundred ninety-nine case studies were selected through a purposive sampling approach. The necessary data was acquired using semi-structured questionnaires, which were filled out during one-on-one interviews conducted by methadone case managers. Clinical case data was obtained from out-patient department systems. The acquired data were processed and analyzed using descriptive statistics, the chi-square, and the .2-series of the related and binary logistic regression. The results of this study are summarized as follows:

1.The majority of participants in this study are men (87.0%), have a junior high school education level (50.2%), are aged between 31 and 40 y (41.7%), and first used heroin when they were aged between 21 and 30 y (45.7%). Among the participants of this study, 71 (12.4%) are HIV positive, 514 (93.1%) are hepatitis C positive, and 382 (67.4%) tested positive for morphine in the urine screening test. The average methadone dosage of participants was 38.88 mg/d during the period of this study.
2.Regarding the participants’ knowledge of methadone, the overall ratio of correct replies on methadone knowledge items is high, indicating that the majority of participants’ methadone knowledge is correct.
3.The answer distribution from the majority of participants on the various dimensions of craving measurement questions is “agree.” This indicates that the participants’ cravings for heroin are moderate-to-high, and that they continue to crave heroin even after rehabilitation with methadone.
4.Participants’ methadone knowledge and craving attitude are positively correlated, indicating that participants scoring higher on methadone knowledge also score higher on craving attitude.
5.Among the participants in this study, 65.4% (242) have discontinued using heroin, whereas 34.6% (128) have relapsed.
6.There is no significant difference between HIV screening results and heroin relapse behavior. There is a significant difference between Hepatitis C screening results and heroin relapse behavior.
7.The results of logistic regression analysis on heroin relapse behavior showed that the statistically significant variables are “the most recent hepatitis C examination result,” “age,” “age of first heroin use,” “most recent methadone dosage,” and “craving attitude — compulsive behavior.”

並列關鍵字

methadone treatment ； methadone knowledge ； heroin craving ； heroin addiction

參考文獻

江淑娟、張景瑞、孫效儒、陳炯旭、詹宏裕、陳為堅 (2006)。男海洛因勒戒犯之再犯率的危險因子。臺灣精神醫學。20（1）：32-43。

李思賢、吳憲璋、黃昭正、王志傑、石倩瑜 (2010)。毒品罪再犯率與保護因子研究：以基隆地區為例。犯罪學期刊，13（1），81-106。

林昭卿、賴美信、蘇惠珍（2000）。社區婦女愛滋病的知識、態度、及衛教需求之調查研究。弘光學報，34。1-40。

林瑞欽、黃秀瑄（2005）。海洛因成癮者濫用藥物信念與用藥渴求信念初探。犯罪學期刊，7 (2)，29-66。

陳光輝、林志強、諶立中（2007）。海洛因成癮者之美沙酮美沙冬療法。醫學繼續教育，11 (3)，315~319。