藥物渴求與美沙酮治療病人持續使用海洛因之關聯性

Craving is Related to Persisting Heroin Use among Patients in Methadone Maintenance Treatment

目的：美沙酮維持治療有效治療鴉片類藥物依賴，但效果常因治療中持續使用海洛因大打折扣，本研究旨在調查美沙酮維持治療病人，治療期間持續使用非法鴉片藥物之相關因素。方法：本研究收集共90 位接受美沙酮維持治療病人，收集性別、年齡、安非他命及海洛因濫用史、婚姻、職業狀況、美沙酮劑量，使用貝克憂鬱量表評估憂鬱狀態、使用貝克焦慮量表評估焦慮狀態、使用匹茲堡睡眠量表評估睡眠狀態及渴藥程度評估，用統計分析來評估其關聯性。結果：90 位美沙酮維持治療病人中，48 位 (53.3%) 尿液嗎啡檢測陽性，在性別、職業、婚姻、憂鬱、焦慮及睡眠狀態及美沙酮劑量與其均無顯著的相關。病人的海洛因之渴藥程度，與治療中持續使用海洛因有明顯的較高 (37.94 ± 33.98 vs. 20.07 ± 25.78, p <0.01)。結論：研究結果顯示海洛因渴藥程度，與美沙酮維持治療病人持續使用海洛因有顯著的關聯，我們需要更多探討美沙酮維持治療病人其渴藥程度之相關研究，將來可以做為病人合併使用海洛因之評估應用。

Objective: Methadone maintenance treatment (MMT) is recognized as an effective treatment in patients with opiate use disorder. But its effect is compromised due to the high incidence of relapse to use heroin. In this study, we intended to investigate factors related to illicit opioid use in MMT patients. Methods: In 90 MMT patients, we collected information of demographic data, opioid urine screen results, heroin and amphetamine abuse history, daily methadone dose, heroin craving visual analogue scale (VAS), Beck Anxiety Inventory score, Beck Depression Inventory II score, and Pittsburgh Sleep Quality Index (PSQI) score. We tested the difference between groups. Results: Of 90 MMT patients, 48 of them (53.3%) were found to have positive opioid urine. Variables such as age, gender, severity of anxiety and depression, sleep quality, and daily methadone dosages were not found to be signifi cantly related to patients’ positive opioid urine. A signifi cant difference existed in the heroin craving scores between patients with positive opioid urine and those with negative opioid urine group (37.94 ± 33.98 vs. 20.07 ± 25.78, p < 0.01). But patients with higher level of heroin craving were more to have illicit opioid use. Conclusion: Heroin craving was associated with persistent heroin use among our MMT patients. Further studies are needed to clarify the complex relationships between the multidimensional nature of craving and severity of heroin dependency or mental distress to develop optimal treatment strategies.