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オピオイド依存症の治療における中等量対高用量メタドン:ランダム化試験
E C Strain1, G E Bigelow, I A Liebson
1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. ecsgss@aol.com
JAMA
|March 23, 1999
まとめ
高用量メタドン塩化水素による治療は,中程度の用量と比較して,オピオイド依存症の患者における違法オピオイド使用を著しく減少させた. 両方の投与量は解毒と維持に役立ちましたが,高用量のメタドンは違法なオピオイドの使用を減らすのにより大きな効果を示しました.
科学分野:
- 依存症医学 薬物中毒医学
- 薬理学 薬理学とは
- クリニック・トライアル 臨床試験
背景:
- メタドン塩化水素は,オピオイド依存症の主要な薬理学的治療法です.
- 専門診療所を超えてメタドン治療へのアクセスを拡大することに関心が高まっている.
- より高いメタドン用量を調査する制御試験は不足しています.
研究 の 目的:
- オピオイド依存症の治療における中等用量メタドンと高用量メタドンの臨床効果を比較する.
- 違法オピオイド使用と治療の継続に対する異なるメタドン用量の影響を評価する.
主な方法:
- 1992年6月から1995年10月まで40週間のランダム化,ダブルブラインド臨床試験が実施されました.
- 外来薬物乱用研究クリニックの資格のある患者192人は,カウンセリングとともに,毎日口服メタドン塩化水素 (40-50 mgまたは80-100 mg) を受けていました.
- 主なアウトカム指標には,オピオイド陽性尿検査結果と治療継続が含まれていました.
主要な成果:
- 高用量メタドン (80~100mg) を投与された患者は,中量投与群 (53.0%対61.9%,P=0.047) と比較して,第30週までにオピオイド陽性尿サンプルが有意に低い割合を示した.
- これらの違法オピオイド使用の減少は,メタドン離脱期間中に持続しました.
- グループ間の治療継続において有意な差は認められなかった (平均継続期間は159日対157日).
- 高用量グループでは解毒の完了率が高く (33%対20%).
結論:
- メタドン塩化水素の適度量および高用量の両方が,メンテナンスおよび解毒の間に違法オピオイドの使用を効果的に減少させた.
- 高用量メタドン治療は,オピオイド依存症の患者の間で違法オピオイドの使用を減らすのに優れた有効性を示しました.
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