海洛因成癮者持續接受美沙冬維持治療之預測因子研究

The Predictors of Retention in Methadone Maintenance Treatment among Heroin-Dependent Individuals

謝明鴻(Ming-Hong Hsieh)

指導教授 ： 賴德仁

中山醫學大學/醫學院/醫學研究所/博士(2012年)

https://doi.org/10.6834/CSMU.2012.00159

摘要

海洛因成癮個案接受美沙冬維持療法治療時間長短及門診留存率已被證實與治療的成功及較好的預後有重要相關。治療留存率及影響的相關因子長期以來一直是改善鴉片類藥物成癮治療方案的重要研究課題。 由於台灣美沙冬門診治療留存率大多比歐美及國外很多國家美沙冬門診低，因此本研究之目的在探討中部海洛因成癮個案在兩家醫院門診接受美沙冬維持治療一年的治療留存率及中止治療的危險因子，以作為改善治療成效及提供未來美沙冬門診治療模式改進的參考。本研究採用前驅性、非隨機的世代研究，並以存活分析進行接受美沙冬治療個案的中止治療風險評估。本研究共有995位海洛因成癮個案在中山醫學大學附設醫院及草屯療養院接受門診美沙冬維持治療並經同意後加入研究。本研究所使用的量表包括物質依賴嚴重度量表中文版、生活品質量表(台灣版) 、衝動控制量表、家庭關懷量表、流行病學研究中心憂鬱量表。本研究顯示門診留存率在治療第3個月時為65.7%，第6個月時為61.7%，在12個月時為58.6%，前3 個月是個案中止治療比例最高的時期。本研究發現與同居人或朋友同住的藥癮個案、女性藥癮個案、無緩起訴身份、使用較低美沙冬劑量（小於60毫克）、較低家庭支持及剛接受治療時有較高的心理範疇滿意度的個案皆是美沙冬門診維持治療一年期間中止治療的相關危險因素。建議在治療前三個月應特別注意具備高風險因素而容易中止美沙冬門診治療的個案以減少個案流失；並建議未來能進行更長期的追蹤研究以探討所有會影響藥癮個案持續接受美沙冬維持治療之相關因子，以期能提高門診留存率，而改善預後及達到減少使用海洛因的治療目標。

關鍵字

海洛因 ； 美沙冬維持治療 ； 門診留存率 ； 危險因子 ； 預測因子

並列摘要

The importance and contribution of both the duration of receiving methadone maintenance treatment and the retention in treatment were well established for therapeutic success and better prognosis of heroin dependence. Retention in treatment and its related factors have been the important issues of research in improving the outcome of treatment program of heroin addiction. The rates of retention in treatment in Taiwan were lower than those of Europe, USA and other countries in the world. The goals of our survey were to detect the retention in treatment and its related factors of the patients with heroin addiction after receiving methadone maintenance treatment for one year in two hospitals in middle Taiwan, and the study results could improve the treatement outcome and establish the suitable treatment programs of heroin addiction in the future. The design of our study was a prospective, non-randomized cohort study and survival analysis was used to evaluate the risk factors of drop-out rate and stopping methadone maintenance therapy. Our sample composed of 995 patients with heroin dependence who received methadone maintenance therapy in the clinics of Chung Shan medical university medical center and Tsaotun psychiatric center, and they all agreed to take part in the survey. The measurement of the related risk factors in our study included the Severity of Dependence Scale, SDS (SDS-ch), World Health Organization Quality of Life (WHOQOL) questionnaire, Barratt Impulsiveness Scale, Family APGAR score, and the Center for Epidemiological Studies Depression Scale（CES-D）. The results of our survey showed that the retention in treatment was 65.7% in the third month, 61.7% in the sixth month, 58.6% in the twelfth month, and the drop-out rate was highest during the first 3 months of the treatment. The results of our study also demonstrated that those patients living with the sexual partner or their friends, being female, having no deferred prosecution, using lower dosage of methadone（lower than 60 mg）, poorer family support, higher psychological satisfaction of quality of life may increase the risk of stopping methadone maintenance treatment during the period of one-year treatment. It is important for the therapists to closely monitor those patients who have the above risk factors and it may decrease the drop-out rate. Besides, longer period of cohort study is warranted to study all risk factors, which may have impact on the retention in treatment of methadone maintenance therapy, then it may increase the retention in treatment and improve the treatment outcome. Therefore the treatment goal of decreasing the use of heroin may be achieved.

並列關鍵字

heroin ； methadone maintenance treatment ； retention in treatment ； risk factor ； predictor

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