海洛因(Heroin)是目前台灣地區中最常見的麻醉藥物濫用之一,並且有逐年增加的趨勢。海洛因成癮病患常因爲擔心法律的問題而不願意主動就醫,因此內科與急診的醫師常有機會因爲急症而第一線接觸及提供相關醫療服務,對於此類病患之健康促進扮演關鍵的角色。近年來我國毒癮愛滋病患呈直線增加,爲儘速控制疫情,衛生署參考其他國家之減少傷害策略,於民國九十四年十二月六日通過「毒品病患愛滋減害試辦計畫」後,積極推動清潔針具計畫,並陸續在各地推動替代療法,以期降低毒品對整體社會的傷害;另衛生署亦於九十五年三月公告及九十五年十月修訂的「鴉片類物質成癮替代療法作業基準」及九十六年二月編譯「美沙冬替代療法治療指引」,顯示衛生主管當局重新審視及思索此一不曾消失的健康危害問題及國內對於藥物濫用觀念的突破。臨床醫師們治療藥癮合併其他併發症之病患,應使用其次團體的語言,期深入了解病患實際狀況,並增加病患的信任感及配合度,對於藥癮之症狀及處置亦應充分了解,並照會相關科別共同治療,病患若未能及時參予合法的嗎啡類藥物替代療法時,仍應考慮利用現有可行的藥物儘可能地緩解病患的戒斷症狀,並應以提供全人的治療爲目標包括:提供或轉介藥物及血液傳染疾病的篩檢,適切的疫苗注射,評估精神疾患及危險行爲及適當的衛教等。
Heroin is one of the most popular illicit drugs in Taiwan and the incidence increased gradually in recent years. Heroin addicted patients are unlikely to contact medical services actively; hence internists and emergency physicians who care for their medical conditions play a pivotal role in promoting their health. The introduction of methadone maintenance therapy (MMT) to Taiwan in 2005 revealed a breakthrough in prospect of this long exiting medical and legal threatening. To increase the patients’ compliance, clinicians need to use jargons to communicate effectively. If MMT is not readily available, clinicians should be able to treat withdraw syndrome as properly by using available but limited opioid or non-opioid replacement therapies. Consultation of psychiatrist or specialist who are familiar with heroin addiction are mandatory. Clinicians should provide screening tests of other illicit drug uses and blood-born infectious diseases, appropriate vaccinations, psychological status evaluation and health-promotion education.