台灣北部地區美沙冬替代療法實施背景、成效及成本效益：三年期追蹤研究（二）
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Date
2009/1/1-2009/12/31
Authors
李思賢
馬羽儀
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Abstract
本研究計畫為了能夠完整的評估各項成效指標，估計美沙冬醫療成本效益、勞動成本及社會成本效益，採用三年期縱貫型追蹤設計，依據短期、中期、與長期來檢視從民國95年以後衛生署所進行的美沙冬替代療法進行之相關成效。 因此，本研究建立成效指標包含六大項：留置率、海洛因再使用、死亡率、毒品以外之犯罪情形、生活品質、及就業率；97年主要目的是協調台北市、台北縣、基隆市、與宜蘭縣的美沙冬替代療法場所，瞭解目前的政策運作情形，以及申請IRB和收取參與美沙冬替代療法個案，預計收取台北市、台北縣、基隆市與宜蘭縣共計樣本至少500名海洛因使用者，建立美沙冬個案的各項基本資料、過去犯罪資料、藥物使用史、及目前成癮狀況等；（2）依據文獻編制施測工具，進行施測工具之專家信、效度評估；（3）分析美沙冬短期成效，主要是海洛因再使用狀況、以及生活品質。本計畫97年度8月為止，已完成各地衛生單位和毒品危害防治中心運作瞭解、衛生單位與醫院間行政聯繫、各參與醫院IRB審查、理論架構的建立、第一年成效評估指標的設定、第一年問卷的設計，以及資料分析架構。 本研究第一年已完成505名個案第一份問卷之訪問和基本生理篩檢資料的蒐集。本研究計劃98年為此研究之第二年；第二年為中期成效評估，主要目的（1）是持續第一年至少500位美沙冬個案之每六個月的追蹤，持續了解其使用美沙冬情形，包括每一位使用的劑量；若有流失之個案，也將請衛生局與毒品危害防治中心協助聯繫，進行接觸與瞭解流失個案狀況；（2）分析美沙冬使用劑量與海洛因再使用（lapse）或是復發（relapse）之關係；（3）開始分析參與美沙冬的持續性，同時用存活分析考慮時間變項後，分析藥物再使用、死亡率、毒品以外之犯罪情形的危險因子；第三年是長期成效分析，主要是回答美沙冬替代療法延續三年後，對於藥癮戒治是否有長期成效，因此主要是（1）持續美沙冬個案之每六個月的追蹤與評量；（2）分析美沙冬個案長期參與、斷斷續續參與、與中途離開美沙冬三種藥癮族群在死亡率、藥物再使用、犯罪率、生活品質、以及就業率上之成效；（3）依據三年之研究成果撰寫成效總報告，並（4）合併成本效益之評估撰寫政策建議書。
This study aims to evaluate long-term effectiveness of methadone treatment in areas of cost-benefit, drug lapse, quality of life, retention rate, mortality rate and employment rate through three-year follow-up research. Four counties were recruited in this study. Questionnair was designed according to the evaluated indexes above. Nine parts are included in the questionnaire: personal information, the dosage of methadone, physical screen, income and employment, the scale of craving for Heroin, Quality of Life, KAP inquires, Stages of Chagne inquires, and Addiction Severity Index. The 1st year research had recruited 505 heroin users from methadone clinics located within Taipei county, Taipei city, I-lan county, and Keelung county between July and November, 2008. This is the 2nd yer project. This research aims to evaluate longitudinal effectiveness of methadone maintenance treatment in terms of cost-benefit, drug lapse, quality of life, mortality rate, and employment rate through three-year follow-ups. The objectives of second year are (1) continue the 500 IDUs follow-ups, (2)describe the lapse and relapse rates, (3) examine methadone retention rates, drug lapse, mortality rates, and criminal activities using survival analysis. The objectives of third year are to (1) evaluate the long-term effects of methadone treatment, (2) examine the differences of three groups on morality, drug lapse, quality of life, employment, and criminal activities, and (4) write policy suggestions about harm reduction policy and alternatives in combination with cost estimates.
This study aims to evaluate long-term effectiveness of methadone treatment in areas of cost-benefit, drug lapse, quality of life, retention rate, mortality rate and employment rate through three-year follow-up research. Four counties were recruited in this study. Questionnair was designed according to the evaluated indexes above. Nine parts are included in the questionnaire: personal information, the dosage of methadone, physical screen, income and employment, the scale of craving for Heroin, Quality of Life, KAP inquires, Stages of Chagne inquires, and Addiction Severity Index. The 1st year research had recruited 505 heroin users from methadone clinics located within Taipei county, Taipei city, I-lan county, and Keelung county between July and November, 2008. This is the 2nd yer project. This research aims to evaluate longitudinal effectiveness of methadone maintenance treatment in terms of cost-benefit, drug lapse, quality of life, mortality rate, and employment rate through three-year follow-ups. The objectives of second year are (1) continue the 500 IDUs follow-ups, (2)describe the lapse and relapse rates, (3) examine methadone retention rates, drug lapse, mortality rates, and criminal activities using survival analysis. The objectives of third year are to (1) evaluate the long-term effects of methadone treatment, (2) examine the differences of three groups on morality, drug lapse, quality of life, employment, and criminal activities, and (4) write policy suggestions about harm reduction policy and alternatives in combination with cost estimates.