处方海洛因治疗顽固性海洛因成瘾者的效果分析
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摘要
海洛因成瘾者的治疗一直是世界各国面临的难题。虽然当前大多数国家将美沙酮维持疗法(MMT)作为治疗海洛因成瘾的第一选择,但是,并不是所有的海洛因成瘾者都能够从美沙酮维持治疗中获益,特别是对于顽固性海洛因成瘾者。已有的研究表明,对于顽固性海洛因成瘾者,海洛因辅助疗法(HAT)能够有效地改善其生理健康、心理健康和社会功能。但是,海洛因辅助治疗仍存在一些需要解决的问题,例如HAT的实践操作、治疗效果以及公众态度等,因此,其对不同国家的适用性还需要进一步考察。
The treatment of heroin addicts has always been a difficult problem facing all countries in the world. Although methadone maintenance therapy(MMT) is currently the first choice for heroin addiction in most countries, not all heroin addicts can benefit from methadone maintenance therapy, especially for intractable heroin addicts. Previous studies have shown that heroin-assisted therapy(HAT) can effectively improve the physical health, mental health and social function of intractable heroin addicts. However, there are still some problems to be solved in the heroin-assisted therapy, such as the practical operation of HAT, therapeutic effect and public attitude, so the applicability of HAT to different countries needs to be further investigated.
The treatment of heroin addicts has always been a difficult problem facing all countries in the world. Although methadone maintenance therapy(MMT) is currently the first choice for heroin addiction in most countries, not all heroin addicts can benefit from methadone maintenance therapy, especially for intractable heroin addicts. Previous studies have shown that heroin-assisted therapy(HAT) can effectively improve the physical health, mental health and social function of intractable heroin addicts. However, there are still some problems to be solved in the heroin-assisted therapy, such as the practical operation of HAT, therapeutic effect and public attitude, so the applicability of HAT to different countries needs to be further investigated.
引文
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[12] Lintzeris N.Prescription of heroin for the management of heroin dependence:current status[J].CNS drugs,2009,23(6):463-476.
[13] Blanken P,Hendriks V M,Koeter M W,Van Ree J M,& Van Den Brink W.Matching of treatment-resistant heroin-dependent patients to medical prescription of heroin or oral methadone treatment:results from two randomized controlled trials[J].Addiction,2005,100(1):89-95.
[14] Eiroa-Orosa F J,Haasen C,Verthein U,Dilg C,Sch fer I,& Reimer J.Benzodiazepine use among patients in heroin-assisted vs methadone maintenance treatment:findings of the German randomized controlled trial[J].Drug and Alcohol Dependence,2010,112(3):226-233.
[15] Haasen C,Verthein U,Degkwitz P,Berger J,Krausz M,& Naber D.Heroin-assisted treatment for opioid dependence Randomised controlled trial[J].The British Journal of Psychiatry,2007,191(1):55-62.
[16]Kuo I,Fischer B,& Vlahov D.Consideration of a North American heroin-assisted clinical trial for the treatment of opiate-dependent individuals[J].International Journal of Drug Policy,2000,11(5):357-370.
[18] [42] [44] Brehmer C,& Iten,P X.Medical prescription of heroin to chronic heroin addicts in Switzerland- a review[J].Forensic science international,2001,121(1):23-26.
[19] Dürsteler-MacFarland K M,Fischer D A,Mueller S,Schmid O,Moldovanyi A,& Wiesbeck G A.Symptom complaints of patients prescribed either oral methadone or injectable heroin[J].Journal of Substance Abuse Treatment,2010,38(4):328-337.
[20] Oviedo-Joekes E,Guh D,Marsh D C,Brissette S,Nosyk B,Krausz M,et al.Characteristics and response to treatment among Aboriginal people receiving heroin-assisted treatment[J].Canadian Journal of Public Health,2010,101(3):210-212.
[22] Perneger T V,Giner F,del Rio M,& Mino A.Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments[J].British Medical Journal,1998,317(7150):13-18.
[23] Oviedo-Joekes E,Guh D,Brissette S,Marsh D C,Nosyk B,Krausz M,et al.Double-blind injectable hydromorphone versus diacetylmorphine for the treatment of opioid dependence:a pilot study[J].Journal of substance abuse treatment,2010,38(4):408-411.
[24] Perneger T V,Giner F,del Rio M,& Mino A.Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments[J].British Medical Journal,1998,317(7150):13-18.
[25][39][53] Steffen T,Uchtenhagen A,Gutzwiller F,Dobler-Mikola A,& Blttler,R.Heroin-assisted treatment of opiate dependent patients Experiences from Swiss trials for medical prescription of narcotics (PROVE)[J].Der Internist,1999,40(6):651-656.
[27] [33] [45] [64] Verthein U,Bonorden-Kleij K,Degkwitz P,Dilg C,K hler W K,Passie T,et al.Long-term effects of heroin-assisted treatment in Germany[J].Addiction,2008,103(6):960-966.
[28] Oviedo-Joekes E,Brissette S,Marsh D C,Lauzon P,Guh D,Anis A,et al.Diacetylmorphine versus methadone for the treatment of opioid addiction[J].New England Journal of Medicine,2009,361(8):777-786.
[31] Kovas A E,McFarland B H,McCarty D J,Boverman J F,& Thayer J A.Buprenorphine for acute heroin detoxification:Diffusion of research into practice[J].Journal of substance abuse treatment,2007,32(2):199-206.
[36] Karow A,Reimer J,Sch fer I,Krausz M,Haasen C,& Verthein U.Quality of life under maintenance treatment with heroin versus methadone in patients with opioid dependence[J].Drug and Alcohol Dependence,2010,112(3):209-215.
[43] Lasnier B,Brochu S,Boyd N,& Fischer B.A heroin prescription trial:Case studies from Montreal and Vancouver on crime and disorder in the surrounding neighbourhoods International[J].Journal of Drug Policy,2010,21(1):28-35.
[46] Haasen C,Eiroa-Orosa F J,Verthein U,et al.Effects of heroin-assisted treatment on alcohol consumption:findings of the German randomized controlled trial[J].Alcohol,2009,43(4):259-264.
[47] Verthein U,Sch fer I,Degkwitz P.[Social integration after 4 years of heroin-assisted treatment].[J].Die Rehabilitation,2013,52(4):244-251.
[48] Marchand K I,Oviedojoekes E,Guh D,et al.Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency[J].BMC Health Services Research,2011,11(1):1-10.
[49] Blanken P,Hendriks V M,Koeter M W J,et al.Matching of treatment‐resistant heroin‐dependent patients to medical prescription of heroin or oral methadone treatment:results from two randomized controlled trials[J].Addiction,2005,100(1):89-95.
[50] Frank V A.EMCDDA INSIGHTS 11,New heroin-assisted drug treatment – Recent evidence and current practices of supervised injectable heroin treatment in Europe and beyond,John Strang,Teodora Groshkova and Nicola Metrebian[J].Drugs Education Prevention & Policy,2013,20(2):160-161.
[51] Metrebian N,Groshkova T,Hellier J,et al.Drug use,health and social outcomes of hard-to-treat heroin addicts receiving supervised injectable opiate treatment:secondary outcomes from the Randomized Injectable Opioid Treatment Trial (RIOTT)[J].Addiction,2015,110(3):479-490.
[52] Strang J,Groshkova T,Uchtenhagen A,et al.Heroin on trial:systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction.[J].British Journal of Psychiatry,2015,207(1):5-14.
[54] Wakeman S.Prescribing heroin for addiction:Some untapped potentials and unanswered questions[J].Criminology & Criminal Justice,2015,15(5):578-593.
[55]Stoermer R,Drewe J,Dursteler-Mac Farland K M,Hock C,Mueller-Spahn F,Ladewig D,et al.Safety of injectable opioid maintenance treatment for heroin dependence[J].Biological psychiatry,2003,54(8):854-861.
[57] Cruz M F,Patra J,Fischer B,Rehm J,& Kalousek K.Public opinion towards supervised injection facilities and heroin-assisted treatment in Ontario,Canada[J].International Journal of Drug Policy,2007,18(1):54-61.
[58] Byford S,Barrett B,Metrebian N,et al.Cost-effectiveness of injectable opioid treatment v.oral methadone for chronic heroin addiction.[J].Br J Psychiatry,2013,203(5):341-349.
[59] Khan R,Khazaal Y,Thorens G,et al.Understanding Swiss drug policy change and the introduction of heroin maintenance treatment[J].European addiction research,2014,20(4):200-207.
[60] Walter M,Denier N,Gerber H,et al.Orbitofrontal response to drug-related stimuli after heroin administration.[J].Addiction Biology,2015,20(3):570–579.
[61] Weiss R D,Griffin M L,Potter J S,et al.Who benefits from additional drug counseling among prescription opioid-dependent patients receiving buprenorphine-naloxone and standard medical management[J].2014,140:118-122.
[62] March J C,Oviedo-Joekes E,Perea-Milla E,et al.Controlled trial of prescribed heroin in the treatment of opioid addiction.[J].Journal of Substance Abuse Treatment,2006,31(2):203-211.
[63] Eiroaorosa F J,Haasen C,Verthein U,et al.Benzodiazepine use among patients in heroin-assisted vs.methadone maintenance treatment:findings of the German randomized controlled trial.[J].Drug Alcohol Depend,2010,112(3):226-233.
[2] Oviedo-Joekes E,Nosyk B,Brissette S,Chettiar J,Schneeberger P,Marsh D C,et al.The North American Opiate Medication Initiative (NAOMI):profile of participants in North America’s first trial of heroin-assisted treatment[J].Journal of Urban Health,2008,85(6):812-825.
[3][17][21] [35] [37] Blanken P,Hendriks V M,Van Ree J M,& Van Den Brink W.Outcome of long-term heroin-assisted treatment offered to chronic,treatment-resistant heroin addicts in the Netherlands[J].Addiction,2010,105(2):300-308.
[4] Strang J,Metrebian N,Lintzeris N,Potts L,Carnwath T,Mayet S,et al.Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT):a randomised trial[J].Lancet,2010,375(9729):1885-1895.
[5][29][30][41][56] Duke K.Exchanging expertise and constructing boundaries:The development of a transnational knowledge network around heroin-assisted treatment[J].International Journal on Drug Policy,2015,31:56-63.
[6] Blanken P,van Den Brink W,Hendriks V M,Huijsman I A,Klous M G,Rook E J,et al.Heroin-assisted treatment in the Netherlands:History,findings,and international context[J].European Neuropsychopharmacology,2010,20(Suppl 2):S105-S158.
[7][26] [32] [34] [38] Haasen C,Verthein U,Eiroa-Orosa F J,et al.Is heroin-assisted treatment effective for patients with no previous maintenance treatment Results from a German randomised controlled trial[J].European addiction research,2010,16(3):124-130.
[8] Oviedo-Joekes E,Nosyk B,Marsh D C,Guh D,Brissette S,Gartry C,et al.Scientific and political challenges in North America’s first randomized controlled trial of heroin-assisted treatment for severe heroin addiction:Rationale and design of the NAOMI Study[J].Clinical Trials,2009,6(3):261-271.
[9] [40] Schulte B,Schütt S,Brack J,Isernhagen K,Deibler P,Dilg C,et al.Successful treatment of chronic hepatitis C virus infection in severely opioid-dependent patients under heroin maintenance[J].Drug and alcohol dependence,2010,109(1-3):248-251.
[10] Rook E J,Huitema A D,van Den Brink W,Hillebrand M J,van Ree J M,& Beijnen J H.Screening for illicit heroin use in patients in a heroin-assisted treatment program[J].Journal of analytical toxicology,2006,30(6):390-394.
[11] Oviedo-Joekes E,Sordo L,Guh D,Marsh D C,Lock K,Brissette S,et al.Predictors of non-use of illicit heroin in opioid injection maintenance treatment of long-term heroin dependence[J].Addictive behaviors,2015,41:81-86.
[12] Lintzeris N.Prescription of heroin for the management of heroin dependence:current status[J].CNS drugs,2009,23(6):463-476.
[13] Blanken P,Hendriks V M,Koeter M W,Van Ree J M,& Van Den Brink W.Matching of treatment-resistant heroin-dependent patients to medical prescription of heroin or oral methadone treatment:results from two randomized controlled trials[J].Addiction,2005,100(1):89-95.
[14] Eiroa-Orosa F J,Haasen C,Verthein U,Dilg C,Sch fer I,& Reimer J.Benzodiazepine use among patients in heroin-assisted vs methadone maintenance treatment:findings of the German randomized controlled trial[J].Drug and Alcohol Dependence,2010,112(3):226-233.
[15] Haasen C,Verthein U,Degkwitz P,Berger J,Krausz M,& Naber D.Heroin-assisted treatment for opioid dependence Randomised controlled trial[J].The British Journal of Psychiatry,2007,191(1):55-62.
[16]Kuo I,Fischer B,& Vlahov D.Consideration of a North American heroin-assisted clinical trial for the treatment of opiate-dependent individuals[J].International Journal of Drug Policy,2000,11(5):357-370.
[18] [42] [44] Brehmer C,& Iten,P X.Medical prescription of heroin to chronic heroin addicts in Switzerland- a review[J].Forensic science international,2001,121(1):23-26.
[19] Dürsteler-MacFarland K M,Fischer D A,Mueller S,Schmid O,Moldovanyi A,& Wiesbeck G A.Symptom complaints of patients prescribed either oral methadone or injectable heroin[J].Journal of Substance Abuse Treatment,2010,38(4):328-337.
[20] Oviedo-Joekes E,Guh D,Marsh D C,Brissette S,Nosyk B,Krausz M,et al.Characteristics and response to treatment among Aboriginal people receiving heroin-assisted treatment[J].Canadian Journal of Public Health,2010,101(3):210-212.
[22] Perneger T V,Giner F,del Rio M,& Mino A.Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments[J].British Medical Journal,1998,317(7150):13-18.
[23] Oviedo-Joekes E,Guh D,Brissette S,Marsh D C,Nosyk B,Krausz M,et al.Double-blind injectable hydromorphone versus diacetylmorphine for the treatment of opioid dependence:a pilot study[J].Journal of substance abuse treatment,2010,38(4):408-411.
[24] Perneger T V,Giner F,del Rio M,& Mino A.Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments[J].British Medical Journal,1998,317(7150):13-18.
[25][39][53] Steffen T,Uchtenhagen A,Gutzwiller F,Dobler-Mikola A,& Blttler,R.Heroin-assisted treatment of opiate dependent patients Experiences from Swiss trials for medical prescription of narcotics (PROVE)[J].Der Internist,1999,40(6):651-656.
[27] [33] [45] [64] Verthein U,Bonorden-Kleij K,Degkwitz P,Dilg C,K hler W K,Passie T,et al.Long-term effects of heroin-assisted treatment in Germany[J].Addiction,2008,103(6):960-966.
[28] Oviedo-Joekes E,Brissette S,Marsh D C,Lauzon P,Guh D,Anis A,et al.Diacetylmorphine versus methadone for the treatment of opioid addiction[J].New England Journal of Medicine,2009,361(8):777-786.
[31] Kovas A E,McFarland B H,McCarty D J,Boverman J F,& Thayer J A.Buprenorphine for acute heroin detoxification:Diffusion of research into practice[J].Journal of substance abuse treatment,2007,32(2):199-206.
[36] Karow A,Reimer J,Sch fer I,Krausz M,Haasen C,& Verthein U.Quality of life under maintenance treatment with heroin versus methadone in patients with opioid dependence[J].Drug and Alcohol Dependence,2010,112(3):209-215.
[43] Lasnier B,Brochu S,Boyd N,& Fischer B.A heroin prescription trial:Case studies from Montreal and Vancouver on crime and disorder in the surrounding neighbourhoods International[J].Journal of Drug Policy,2010,21(1):28-35.
[46] Haasen C,Eiroa-Orosa F J,Verthein U,et al.Effects of heroin-assisted treatment on alcohol consumption:findings of the German randomized controlled trial[J].Alcohol,2009,43(4):259-264.
[47] Verthein U,Sch fer I,Degkwitz P.[Social integration after 4 years of heroin-assisted treatment].[J].Die Rehabilitation,2013,52(4):244-251.
[48] Marchand K I,Oviedojoekes E,Guh D,et al.Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency[J].BMC Health Services Research,2011,11(1):1-10.
[49] Blanken P,Hendriks V M,Koeter M W J,et al.Matching of treatment‐resistant heroin‐dependent patients to medical prescription of heroin or oral methadone treatment:results from two randomized controlled trials[J].Addiction,2005,100(1):89-95.
[50] Frank V A.EMCDDA INSIGHTS 11,New heroin-assisted drug treatment – Recent evidence and current practices of supervised injectable heroin treatment in Europe and beyond,John Strang,Teodora Groshkova and Nicola Metrebian[J].Drugs Education Prevention & Policy,2013,20(2):160-161.
[51] Metrebian N,Groshkova T,Hellier J,et al.Drug use,health and social outcomes of hard-to-treat heroin addicts receiving supervised injectable opiate treatment:secondary outcomes from the Randomized Injectable Opioid Treatment Trial (RIOTT)[J].Addiction,2015,110(3):479-490.
[52] Strang J,Groshkova T,Uchtenhagen A,et al.Heroin on trial:systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction.[J].British Journal of Psychiatry,2015,207(1):5-14.
[54] Wakeman S.Prescribing heroin for addiction:Some untapped potentials and unanswered questions[J].Criminology & Criminal Justice,2015,15(5):578-593.
[55]Stoermer R,Drewe J,Dursteler-Mac Farland K M,Hock C,Mueller-Spahn F,Ladewig D,et al.Safety of injectable opioid maintenance treatment for heroin dependence[J].Biological psychiatry,2003,54(8):854-861.
[57] Cruz M F,Patra J,Fischer B,Rehm J,& Kalousek K.Public opinion towards supervised injection facilities and heroin-assisted treatment in Ontario,Canada[J].International Journal of Drug Policy,2007,18(1):54-61.
[58] Byford S,Barrett B,Metrebian N,et al.Cost-effectiveness of injectable opioid treatment v.oral methadone for chronic heroin addiction.[J].Br J Psychiatry,2013,203(5):341-349.
[59] Khan R,Khazaal Y,Thorens G,et al.Understanding Swiss drug policy change and the introduction of heroin maintenance treatment[J].European addiction research,2014,20(4):200-207.
[60] Walter M,Denier N,Gerber H,et al.Orbitofrontal response to drug-related stimuli after heroin administration.[J].Addiction Biology,2015,20(3):570–579.
[61] Weiss R D,Griffin M L,Potter J S,et al.Who benefits from additional drug counseling among prescription opioid-dependent patients receiving buprenorphine-naloxone and standard medical management[J].2014,140:118-122.
[62] March J C,Oviedo-Joekes E,Perea-Milla E,et al.Controlled trial of prescribed heroin in the treatment of opioid addiction.[J].Journal of Substance Abuse Treatment,2006,31(2):203-211.
[63] Eiroaorosa F J,Haasen C,Verthein U,et al.Benzodiazepine use among patients in heroin-assisted vs.methadone maintenance treatment:findings of the German randomized controlled trial.[J].Drug Alcohol Depend,2010,112(3):226-233.