2020
Tianzhen Chen
Jiang Du
Na Zhong
et al.
Trajectories of heroin use predict relapse risk among heroin-dependent patients: A 5-year follow-up study

Objectives: The relationship between past drug use trajectory and long-term relapse risk after rehabilitation among heroin-dependent patients remain understudied. The primary objectives were to identify longitudinal heroin use patterns of heroin-dependent patients, to determine the associative factors with trajectories and to investigate the impact of trajectory groups on relapse after finishing compulsory rehabilitation programs.

Materials and methods: A total of 564 heroin-dependent patients were recruited from 4 compulsory rehabilitation facilities in Shanghai, China between 2007 and 2008. The baseline data was linked to participants’ follow-up data on relapse from official records. Group-based trajectory model was used to identify distinctive drug use trajectory groups. The association between the identified group and heroin relapse risk was then analyzed to understand the role of past drug use trajectory on relapse.

Results: Five trajectory groups were identified in this cohort: (1) Rapid Decrease (9.9%); (2) Persistent High (32.0%); (3) Slow Decrease (34.1%); (4) Gradual Increase (4.5%); (5) Persistent Low (19.5%). Gender, age, education, and impulsivity were found to be different between the five groups. During the 5 years after discharged from the compulsory program, 291 (59.0%) individuals relapsed. Multivariate logistic regression analysis showed that the persistent high group (OR: 2.77 [1.46–5.24]), slow decrease group (OR: 2.31 [1.32–4.06]) and gradual increase group (OR: 3.50 [1.18–10.39]) was positively associated with the heroin relapse risk when compared to the persistent low group. Conclusions: Heroin use trajectories vary among heroin-dependent patients in China. The trajectories of heroin use before compulsory rehabilitation are associated with subsequent long-term relapse risk.

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2020
UNODC
Международные стандарты лечения расстройств, связанных с употреблением наркотических средств

Настоящий документ, «Международные стандарты лечения расстройств, связанных с употреблением наркотических средств» (далее Стандарты), является результатом совместной работы УНП ООН и ВОЗ по поддержке государств-членов в их усилиях по разработке и продвижению эффективных, основанных на фактических данных и соответствующих принципам этики методов лечения расстройств, связанных с употреблением наркотических средств.

Стандарты предназначены для всех, кто участвует в формировании политики, планировании, финансировании, осуществлении, мониторинге и оценке вмешательств и услуг по лечению расстройств, связанных с употреблением наркотических средств.

Настоящий документ основан на имеющихся в настоящее время научных данных в отношении лечения расстройств, связанных с употреблением наркотических веществ, и является основой для применения Стандартов в соответствии с принципами общественного здравоохранения. Стандарты определяют основные компоненты и характеристики эффективных систем лечения расстройств, связанных с употреблением наркотических средств. Методы лечения и вмешательства, отвечающие потребностям людей на различных этапах и при разной степени тяжести расстройств, связанных с употреблением наркотических средств, описываются так же, как описывается лечение любого хронического заболевания или нарушения здоровья.

Стандарты носят рекомендательный характер, и, следовательно, национальным и местным терапевтическим службам или системам не следует пытаться обеспечить осуществление всех содержащихся в этом документе стандартов и рекомендаций одновременно. Тем не менее, с течением времени и с учетом постоянно улучшающегося качества в целях «научно обоснованной и соответствующей этическим принципам практики» можно и следует ожидать формирования более четко организованных, более эффективных и лучше соответствующих принципам этики систем и служб оказания помощи людям с расстройствами, связанными с употреблением наркотических средств.

УНП ООН и ВОЗ предлагают всем, что отвечает за формирование, планирование, финансирование, осуществление и мониторинг местной и национальной политики, а также тем, кто отвечает за оценку лечения расстройств, связанных с употреблением наркотических средств, сопоставить местные системы и услуги по лечению таких расстройств с положениями Стандартов. Цель состоит в том, чтобы выявить пробелы и области, которые не соответствуют Стандартам, и совместно с соответствующими заинтересованными сторонами провести работу по совершенствованию систем и услуг. Хотя многие принципы и разделы Стандартов могут быть применены к лечению других психических расстройств и расстройств, связанных с употреблением психоактивных веществ (например вызванных употреблением алкоголя или табака), основной приоритетной областью Стандартов являются расстройства, связанные с употреблением наркотических средств.

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2019
Tianzhen Chen
Na Zhong
Jiang Du
et al
Polydrug use patterns and their impact on relapse among heroin-dependent patients in Shanghai, China

Aims To describe the polysubstance use patterns of heroin-dependent patients and to understand the impact of polysubstance use patterns on relapse during the 5 years after completing compulsory rehabilitation programmes. Design In this secondary analysis, the baseline data of 503 heroin-dependent patients were linked with their 5-year follow-up data from official records. Setting Four compulsory rehabilitation centres in Shanghai, China.

Participants A total of 564 heroin-dependent patients who were discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008 were recruited. Among these, 503 patients with available follow-up records were included in this analysis. 

Measurements The baseline measurements included the Addiction Severity Index, the Temperament and Character Inventory and the Medical Outcomes Study Social Support Scale. Relapses after discharge from the compulsory rehabilitation centres were extracted monthly from the official electronic record system. Latent class analysis was used to identify different polysubstance use patterns. Associations between the identified latent classes and heroin use and the factors related to relapse during the 5-year follow-up were analysed with the Cox regression model.

Findings Three latent classes were identified in this cohort: (1) alcohol polydrug users (APU; 13.7%), (2) low polydrug users (LPU; 76.5%) and (3) amphetamine-type stimulant polydrug users (ASPU; 9.7%). During the 5-year follow-up, 298 heroin patients relapsed, and the three groups showed different relapse rates (ASPU 69.4 versus LPU 60.5 versus APU 44.9%, P = 0.02). The average durations of abstinence for the three groups differed (ASPU 31.27 ± 3.41 months versus LPU 36.77 ± 1.19 months versus APU 42.46 ± 2.81months, P = 0.02). Multivariate Cox regression analyses found that the LPU [hazard ratio (HR) = 1.63, 1.06–2.51] and ASPU (HR = 2.10, 1.24–3.56) classes were positively associated with the risk of heroin relapse. Conclusion Polydrug use patterns differ among heroin-dependent patients in compulsory rehabilitation programmes in China. A history of polydrug use may predict heroin relapse risk among patients in those compulsory rehabilitation programmes.

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2019
Tianzhen Chen
Min Zhao
China methadone opioid agonist treatment opioid dependence
Meeting the challenges of opioid dependence in China: experience of opioid agonist treatment

Purpose of review 

This article reviews the role of methadone maintenance treatment (MMT) clinics in minimizing the harms caused by opioid dependence, as well as China’s current challenges in this area. In addition, we aim to discuss the treatment strategies for opioid dependence within the international community in the current global situation of serious abuse of opioids.

Recent findings 

Like other countries facing the opioid crisis, China is actively working on revising policy, improving the addiction treatment system and promotion of MMT clinics to cope with the risks of opioid abuse. As they provide one of the most effective opioid agonist treatments for opioid dependence, MMT clinics play an extremely important role in this campaign. The MMT programme in China has had a significant beneficial effect on reduction of opioid use and the prevalence rate of HIV/AIDS.

Summary 

The efficacy of MMT for patients with opioid dependence in China is confirmed by the present review. However, several important challenges still need to be resolved. China’s treatment experience also provides a reference for other countries facing the danger of opioid dependence.

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2015
Jiang Haifeng
Liang Di
Du Jiang
Gender differences in recovery consequences among heroin dependent patients after compulsory treatment programs

Studies on recovery patterns and how baseline factors influence recovery consequences among heroin dependent patients have shown mixed results. This study is aimed at describing the gender differences in long-term recovery patterns and exploring the predictors of negative recovery consequences by gender among heroin dependent patients in Shanghai, China. At baseline, this study recruited 503 heroin dependent patients discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008. In this cohort study, the baseline data was then linked with participants’ 5-year follow-up data from official records. Generalized Estimating Equations (GEE) were used to compare males with females in terms of the presence of negative consequences (incarceration, or readmission to compulsory treatment, or both), in the subsequent 5-years after their discharge from compulsory treatment. Ordinary least squares (OLS) regression was used to explore factors associated to the time length of negative consequences in 5 years after the discharge for males and females separately. Our findings indicate that female heroin dependent patients tend to have less negative recovery outcomes than male patients. Male patients with a life-time history of poly drug use and female patients with borderline personality disorder are especially at risk of incarceration and readmission into compulsory treatment programs.

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2015
Hang Su
Zhibin Li
Jiang Du
Predictors of Heroin Relapse: Personality Traits, Impulsivity, COMT Gene Val158met Polymorphism in a 5-year Prospective Study in Shanghai, China

Relapse is a typical feature of heroin addiction and rooted in genetic and psychological determinants. The aim of this study was to evaluate the effect of personality traits, impulsivity, and COMT gene polymorphism (rs4680) on relapse to heroin use during 5-year follow up. 564 heroin dependent patients were enrolled in compulsory drug rehabilitation center. 12 months prior to their release, personality traits were measured by BIS-11 (Barratt Impulsiveness Scale-11) and Temperament and Character Inventory (TCI). The COMT gene rs4680 polymorphism was genotyped using a DNA sequence detection system. The heroin use status was evaluated for 5 years after discharged. Among the 564 heroin-dependent patients, 500 were followed for 5 years after discharge and 53.0% (n¼265) were considered as relapsed to heroin use according to a strict monitor system. Univariate analysis showed that age, having ever been in methadone maintenance treatment (MMT), the total scores and nonplanning scores of BIS-11, and the COMT rs4680 gene variants were different between relapse and abstinent groups. Logistic regression analysis showed higher BIS total score, having ever been inMMTand younger first heroin use age are the predictors of relapse to heroin use during 5 years follow-up, and theCOMT rs4680 gene had an interaction with BIS scores. Our findings indicated that the impulsive personality traits, methadone use history, and onset age could predict relapse in heroin-dependent patients during 5 year’s follow up. The COMT gene showed a moderational effect in part the relationship of impulsivity with heroin relapse.

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