【作者】 陈涛；

【导师】 吴尊友； 庞琳；

【作者基本信息】 安徽医科大学 ， 流行病与卫生统计学， 2012， 硕士

【摘要】 目的了解MMT门诊服药人员药物滥用现状、特征、危害程度以及相关行为特征,分析偷吸原因和影响因素,探索杜绝多药滥用的有效干预方法,为提高参加MMT服药人员的依从性提供依据。方法本研究采用定量研究与定性研究相结合的方法。定量研究为横断面调查,以MMT门诊中1 202名服药人员为研究对象,通过问卷调查收集社会人口学特征、多药滥用基本情况、艾滋病相关高危行为等资料,采用吗啡、冰毒、摇头丸、丁丙诺啡、苯二氮卓五合一定性尿检试纸板(广州万孚生物技术有限公司)对研究对象进行尿液检测。对研究对象的多药滥用情况进行描述性分析,对影响多药滥用的因素进行单因素和多因素分析。定性研究为个人深入访谈,共选取25名尿检阳性的服药人员和5名门诊工作人员进行个人深入访谈,对记录资料按照关键词或术语进行编码、归纳和分析。结果1.定量研究结果:1 202名研究对象平均年龄39.7±6.8岁,男性910人(75.7%),汉族1 188人(98.8%),初中及以下文化程度751人(62.5%),无业者682人(56.7%),离异/丧偶220人(18.3%)。调查对象的平均吸食海洛因年限15.6±4.8年,有963人(80.1%)曾采用注射方式使用海洛因,其中291人(30.2%)报告曾经与他人共用过针具;976人(81.2%)曾经接受过强制或劳教戒毒;28人(2.3%)为HIV抗体检测阳性,985人(81.9%)HCV抗体检测阳性。尿检结果显示:尿吗啡阳性率为31.5%,苯二氮卓类阳性率为12.5%,冰毒阳性率为.9.0%,丁丙诺啡阳性率为1.7%,摇头丸阳性率为1.1%,提示目前MMT服药人员仍然以偷吸海洛因为主,同时滥用苯二氮卓类药物和冰毒的现象也比较普遍。问卷结果显示:有360人(30.0%)报告在参加MMT期间仍在滥用多种药物,并且有302人(25.1%)在过去6个月有多药滥用经历。滥用药物种类有海洛因、安定、三唑仑、曲马多、异丙嗪、冰毒、摇头丸、K粉、麻古、吗啡、丁丙诺啡、杜冷丁、可卡因、氯丙嗪、大麻、地芬诺脂、二氢埃托啡、止痛粉、止咳药水等。在360名报告者中滥用率较高的有安定(17.6%),冰毒(12.1%),曲马多(4.4%),麻古(3.7%),异丙嗪(3.2%),和尿检结果基本相符。其中通过注射使用的药物:安定139人(11.6%),异丙嗪37人(3.1%),冰毒9人(0.7%)等。调查对象所在地区、职业、与家人关系、近4个月美沙酮平均剂量、其他物质滥用情况对是否经常偷吸海洛因的影响有统计学意义(P<0.05),无职业、与家人关系好、无其他物质滥用是经常偷吸海洛因的保护因素;而有职业(OR=1.987,95%CI:1.359-2.904)、与家人关系差(OR=2.058,95%CI:1.054-4.015)、有其他物质滥用(OR=2.395,95%CI:1.637-3.506),是经常偷吸海洛因的危险因素;来自不同省(市)、美沙酮近4个月平均治疗剂量对研究对象经常偷吸海洛因的风险也不相同。调查对象所在地区、职业、婚姻状况、有无临时性伴、参加MMT时间、参加MMT之前有其他物质滥用、是否经常偷吸海洛因对服药人员在MMT期间其他物质滥用(除海洛因)的影响有统计学意义(P<0.05),广东地区(OR=0.699,95%CI.0.497-0.982)、有职业(OR=0.705,95%CI:0.541-0.919)是其他物质滥用的保护因素;而江苏地区(OR=1.765,95%CI:1.260-2.473)、有临时性伴(OR=1.595,95%CI:1.008-2.523)、参加MMT前曾经有其他物质滥用(OR=5.304,95%CI:3.693-7.618)、经常偷吸海洛因(OR=2.611,95%CI:1.762-3.869)为其他物质滥用的危险因素。2.定性研究结果:共访谈30人,其中美沙酮门诊工作人员5人,服药人员25人。25名受访服药人员平均年龄(37.7±1.6)岁;男性23人,女性2人;未婚9人,已婚11人,离异5人;与家人关系:较差7人,一般8人,较好10人。受访服药人员在参加美沙酮维持治疗过程中均有多药滥用经历。他们发生多药滥用的原因复杂多样,如为提高快感、外出不便暂时替代等,但很大部分原因是对美沙酮维持治疗的认识不正确,认为长期服用美沙酮对身体会有较大毒副作用、成瘾性大并很难戒掉、不方便工作和生活等,从而想戒除美沙酮也或者逐渐减量最终戒除,在此过程中他们采用其他药物来替代美沙酮或缓解戒断症状进而产生多药滥用行为。结论参加MMT期间服药人员多药滥用现象比较普遍,滥用的药物种类广泛,使用的方式多样,多药滥用的原因也复杂多样,主要是由于对美沙酮维持治疗的认识不正确。因此,需进一步加强对门诊服药人员除海洛因以外其他多种药物的检测和监督,加大对多药滥用及其危害的宣传,并积极研究预防和治疗服药人员多药滥用的措施;另外,在日常的美沙酮维持治疗过程中除了常规的治疗及服务外,还应针对多药滥用加强美沙酮维持治疗知识的健康教育,以减少多药滥用的进一步发生和蔓延。更多还原

【Abstract】 ObjectivesTo determine polydrug abuse status,character,extent of injury and related behaviors among heroin addicts attending methadone maintenance treatment(MMT)program and to identity its associated risk factors.MethodsA cross-sectional study was conducted among 1 202 clients in 6 MMT clinics in Chongqing,Guangdong,and Jiangsu provinces.Demographic information,polydrug abuse status and risky sexual behaviors were collected.Urine specimen was collected to assess morphia,methyl amphetamine,ecstasy,buprenorphine and benzodiazepine testing.Polydrug abuse behaviors were described,and their associated risk factors were assessed using univariate analysis and multivariate analysis.Further in-depth interviews were conducted among 25 urine-positive drug users and 5 methadone clinic doctors.Record data was encoded according to key words or terms.Results1.Results of the cross-sectional survey:The average age of participants was 39.7 ±6.8 years old,and 910(75.7%)participants were male,98.8%of the participants were Han.751(62.5%)people were junior high school education or lower.682(56.7%)participants had no job.Divorced/widowed accounted for 18.3%.Average years of heroin was 15.6 士 4.8 years.963(80.1%)people had used heroin in injecting.Among them,291(30.2%)people reported having shared needles or syringes,976(81.2%)people had received compulsory treatment,28(2.3%)people were HIV-positive,and 985(81.9%)people were HCV-positive.The urine test results:the rate of urine morphine-positive was 31.5%,the rate of benzodiazepine-positive was 12.5%,the rate of methamphetamine-positive was 9.0%,the rate of buprenorphine-positive was 1.7%,the rate of ecstasy-positive was 1.1%.The results suggest that drug abuse of the clients in MMT,heroin-use accounted for a major proportion,at the same time,benzodiazepine-use and methamphetamine-use are also very common.The questionnaire results show:360(30.0%)people reported having polydrug-use while they were still in MMT.The drugs were heroin,valium,triazolam,tramadol,promethazine,methamphetamine,ecstasy,magu,morphine,buprenorphine,pethidine,cocaine,chlorpromazine,marijuana,diphenoxylate,dihydro-etorphine,analgesic powder,cough syrup and so on.The results of analysis indicated that area,occupation,relationship with family,the average dose of methadon,abuse of other drugs were statistically significant for the use of heroin.The results of multivariate analysis indicated that having occupation(OR=1.987,95%CI:1.359-2.904),bad relationship with his family(OR=2.058,95%CI:1.054-4.015),other drugs use(OR=2.395,95%CI:1.637-3.506)were risk factors.Area,occupation,marital status,casual partners,in the MMT time,having other drugs use before being in MMT,heroin-use were statistically significant for other drugs use.Jiangsu(OR=1.765,95%CI:1.260-2.473),having casual partners(OR=1.595,95%CI:1.008-2.523),having other drugs use before being in MMT(OR=5.304,95%CI:3.693-7.618),heroin-use(OR=2.611,95%CI:1.762-3.869)were risk factors.2.Results of qualitative study:We interviewed 30 people,including 5 methadone clinic doctors and 25 drug users.The average age of drug users was 37.7 ± 1.6 years old.Among the 25 drug users,23 ones were male,and 2 ones were female;9 ones were unmarried,11 ones were married,and 5 ones were divorced;Relationship with family:7 ones were poor,8 ones were ordinary,and 10 ones were good.All of them had polydrug use experiences.The reasons for polydrug use were complex and diverse,but misconceptions about MMT were the main reason.Some drug users thought that methadone would be harmful to the body,methadone had greater addiction,and that methadone was inconvenient to work and life.So some drug users intended to quit the methadone or to gradually reduce their doses.Thus they use other drugs to replace methadone or to ease the withdrawal symptoms.ConclusionContinued heroin use and other drugs use was common in MMT clinics.The reasons for polydrug use were complex and diverse,misconceptions about MMT were the main reason,therefore,more effective detection methods should be adopted to detect other drugs in addition to heroin,and effective prevention and treatment measures should be adopted to deal with polydrug use in MMT clinics.更多还原