研究背景:我國自2006年開辦「緩起訴毒品病犯減害替代療法方案」,促使醫療與司法單位結合,共同協助海洛因成癮者戒治。然而緩起訴毒品犯美沙冬戒癮治療方案執行至今已五年,相關研究仍不多見,本研究以北部某署立醫院為例,探索緩起訴美沙冬戒癮治療之執行成效及影響戒癮治療是否完成的相關因素為何。 研究方法:本研究採世代回溯、檔案研究法,以立意取樣方式,收集及分析北部某署立醫院美沙冬門診中,於2007年7月10日至2010年12月31日期間,因受緩起訴處分在該院治療的海洛因毒品犯檔案資料。本研究收集資料包含基本人口學特質等靜態因子資料,以及美沙冬治療劑量等動態因子資料。之後以t檢定、卡方檢定、單因子變異數分析及羅吉斯迴歸分析等統計方法,分析各因子與完成戒癮治療與否之相關性。 研究結果:於全部196名受試樣本中,可持續治療逾6個月、初期完成治療者有139名,佔70.9%;而能持續1年、全程完成治療者為99名,佔50.5%。與初期完成治療相關的因子包括性別、工作、美沙冬喝藥出席率以及嗎啡驗尿陽性率。與全程完成治療相關的靜態因子增加了婚姻狀態及財產犯罪前科;動態因子則增加了最高及最終治療劑量。以靜態因子來看,女性、已婚、有工作、無財產犯罪前科有較高機率完成治療;以動態因子來看,越高的最高治療劑量及越低的最終治療劑量、越高的出席率及越低的驗尿陽性率,越有可能完成治療。動態因子中最穩定的觀察指標為美沙冬喝藥出席率,以ROC曲線來分析最適當的出席率數值,發現高於87.5%的出席率有最顯著的預測率。 結論: 本研究發現多個靜態因子及動態因子都與完成緩起訴美沙冬戒癮治療相關。本研究建議檢察官可參考影響完成治療與否的因素,作為是否判處緩起訴以及是否增加附命條件的決策參考。醫療院所亦可參考本研究之相關因素,及早偵測不利完成治療的高風險個案,對其加強個案管理及輔助治療。
Since 2006, Taiwan has implemented a “deferred prosecution methadone treatment program” for heroin abusers. However, there has been a lack of research regarding the effectiveness of such a program. This research study examines the practices in a hospital in northern Taiwan, analyzing completion rates of methadone treatment and related factors. This research is a retrospective study and selective sampling from a methadone clinic in a northern Taiwan hospital. Data were collected from the period of July 10th, 2007 to December 31, 2010. Prosecution for patients involved had been deferred, and these patients were receiving methadone treatment. Data collected included static factors such as demographic data and dynamic factors such as attendance rate. T-tests, chi-squared tests, ANOVA and regression analyses were used to determine relationships between the factors under examination and treatment completion rates. Of the 196 patients in the study, 139 were able to sustain treatment for six months, representing 70.9% of the total. 99 (50.5%) of the patients were able to sustain their treatments for 12 months (1 year), successfully completing the treatment. Factors related to sustaining the first 6-months treatment include gender、job、 attendance rate and reactive rate of urine test. For completion of the total 12-months treatment,the related factors added identified were marital status, property-related criminal record, the highest and the latest methadone dosage. In this study, we found female, married, employed, without property-related criminal records, higher highest methadone dosage、lower latest dosage、higher attendance rate and lower reactive urine test had greater likelihood of successfully completing the 12-months treatment program. We analyzed the ROC curve for attendance rate and completion treatment, the cut-off value of attendance rate is 87.5%. This research study points out several factors that correlate with higher rates of completing methadone treatment. The results of this study may help judges defer prosecution or specifying additional requests when sentencing heroin abusers. The results may also assist hospitals to more accurately predict patients at higher risk of relapsing, and therefore prompt an alternative treatment program and case management.
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