论文部分内容阅读
经过漫长而激烈的争论,德国于1987年首次引进了美沙酮维持治疗.最初,由于入治标准严格,接受治疗的人数很少,但自1990年后接受治疗的人数迅速上升,到2005年底已有61 000人.在德国每位全科医生只要完成了成瘾医学的培训都允许为阿片类成瘾病人开具替代治疗药物.目前德国有2700个全科医生在为阿片类药物成瘾病人开具处方.每位参加维持治疗的病人需接受社会心理治疗.研究结果和实践经验表明,病人从美沙酮维持治疗中获得了实质性的好处,他们的身心健康得到了改善.美沙酮维持治疗的留治率高(65%-85%),对HIV和肝炎的评估和坚持治疗十分重要;在促进病人回归社会方面也是极其重要的因素;在降低药物相关伤害方面如:减少共患疾病、死亡和预防感染性疾病具有重要的作用.有10%的人在长期的治疗过程中戒掉了毒品.虽然丁丙诺啡正在显示其重要性,但是美沙酮仍是主要的替代药物.在农村,参加美沙酮维持治疗仍是难题.虽然一致认为工作是治疗的正性因素,但对病人来说就业机会很少.德国监狱的替代治疗采用不同的准入和治疗模式.准入治疗不协调,参加治疗的人数很少.无论如何,在德国替代治疗在为药物使用者提供的卫生医疗系统中发挥了重要作用.“,”After a long and controversial debate methadone maintenance treatment (MMT) was first introduced in Germany in 1987. The number of patients in MMT first low because of strict admission criteria - has increased considerably since the 1990s up to 61 000 at the end of 2005. In Germany every general practitioner (GP), who has completed an additional training on addiction medicine, is allowed to prescribe substitution drugs to opioid dependent patients. 2700 GPs are currently prescribing substitution drugs. Psychosocial care should be offered to every MMT patient. The results of research studies and practical experiences indicate that clients benefit substantially from MMT with improvements in physical and psychological health. MMT has high retention rates (65% -85% ) and plays a major role in accessing and maintaining ongoing medical treatment for HIV and hepatitis. MMT is also seen as a vital factor in the social re - integration process. MMT also plays an important role in the reduction of drug related harms such as mortality, morbidity and prevention of infection diseases. Some 10% of MMT clients become drug- free in the long run. Mostly methadone is the most commonly prescribed substitution medication, although buprenorphine is attaining more and more importance. Access to MMT in rural areas is very patchy and therefore constitutes a problem. Also employment opportunities are scare for patients in MMT, although labor is recognized unanimously as a positive factor of the treatment.Substitution treatment in German prisons is heterogeneous in access and treatment modalities. Access is very patchy and the number of inmates in treatment is limited. Nevertheless, substitution treatment plays a substantial part in the health care system provided to drug users in Germany.