初等医療におけるメタドンのメンテナンス:ランダム化制御試験
D A Fiellin1, P G O'Connor, M Chawarski
1Yale University School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025, USA. david.fiellin@yale.edu
JAMA
|October 12, 2001
まとめ
安定したオピオイド依存患者のオフィスベースのメタドン維持は,実行可能で有効です. プライマリケア医は,この治療を提供することができ,患者は従来の麻薬治療プログラム (NTP) に比べて,より高い満足度を示しています.
科学分野:
- 依存症医学 薬物中毒医学
- プライマリーケア (プライマリーケア)
- 公衆衛生は公衆衛生である.
背景:
- メタドン維持は,オピオイド依存症の実証された治療法です.
- 現在の治療は,連邦政府が認可した麻薬治療プログラム (NTP) に限定されています.
- 安定した患者のためのオフィスベースのケアは,制御された試験データを必要とする有望な代替手段です.
研究 の 目的:
- オフィスでのメタドン維持の可行性と有効性を評価する.
- 安定したオピオイド依存症患者のための従来のNTPケアとプライマリケア医師主導の治療を比較する.
主な方法:
- 6ヶ月のランダム化制御されたオープン臨床試験です.
- 47人の安定したオピオイド依存症患者は,訓練されたプライマリーケア医師によるオフィスベースのケア,またはNTPでの通常のケアにランダムに割り当てられました.
- 結果には,違法薬物使用,臨床的不安定性,患者/臨床医の満足度,およびサービスの利用が含まれていました.
主要な成果:
- オフィスベースのグループとNTPグループの間で,違法なオピエット使用または臨床的不安定さの有意な違いはありません.
- オフィスベースのケアを受けた患者は,ケア品質に対する満足度が著しく高かった (73%対13%) と報告しています.
- 機能的な状態や医療,法律,または社会サービスの利用において,違いは認められなかった.
結論:
- 安定したオピオイド依存症の患者をメタドン維持のために主治医の診療所に移すことは,実行可能で効果的です.
- このアプローチは,患者の満足度を高めます.
- 患者の選択と臨床モニタリングのガイドラインが提案されています.
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