Abstract

Background

Although methadone maintenance treatment (MMT) guidelines are well established, patients' characteristics and outcome change over time may be affected by the legality of cannabis.

Objective

To study trend changes between two clinics over 20 years from Las Vegas (LV) and 27 years from Tel Aviv (TA).

Methods

Patients’ characteristics at admission, including drugs in urine at first and 13th month were obtained from their medical charts. Changes by year of admission and cumulative retention were analyzed.

Results

The LV MMT clinic (1724 patients) had a lower one-year retention rate compared to the TA MMT clinic (1014 patients) (46.4% vs. 74.4%, respectively, p < 0.0005), and a higher rate of opioid stop after one year (75.9% vs. 68.8%, respectively, p = 0.003). The age at MMT admission and the retention rates decreased in LV and increased in TA. The prevalence of cannabis and benzodiazepine misuse on MMT admission increased in LV with no change recorded in TA. Cocaine on MMT admission decreased in LV and increased in TA, while amphetamine use increased in LV and decreased in TA. Cox models multivariate analyses found cannabis on admission to predict shorter retention in LV (as younger age male and amphetamines), and cannabis after one year in TA (as did cocaine and opiates after one year and BDZ on admission).

Conclusion

Although cannabis prevalence increased only in LV where it was legalized, it was associated with poor outcomes in both clinics. Younger age, a known poor outcome predictor, may be related to decreased retention in LV.

中文翻译：

---

两个美沙酮维持诊所之间 20 年的趋势差异，一个有大麻合法化，一个没有大麻合法化

摘要

背景

尽管美沙酮维持治疗 (MMT) 指南已经确立，但患者的特征和结果随时间的变化可能会受到大麻合法性的影响。

客观的

研究拉斯维加斯 (LV) 20 年和特拉维夫 (TA) 27 年间两家诊所之间的趋势变化。

方法

患者入院时的特征，包括第 1 个月和第 13 个月尿液中的药物，均从他们的病历中获得。分析了入院年份和累积保留率的变化。

结果

与 TA MMT 诊所（1014 名患者）相比，LV MMT 诊所（1724 名患者）的一年保留率较低（分别为 46.4% 和 74.4%，p  < 0.0005），并且在一次停药后阿片类药物停用率更高年（分别为 75.9% 和 68.8%，p = 0.003）。MMT 入院时的年龄和保留率在 LV 中下降而在 TA 中增加。MMT 入院时大麻和苯二氮卓滥用的流行率在 LV 中增加，但在 TA 中没有记录。MMT 入院时可卡因在 LV 中减少而在 TA 中增加，而苯丙胺使用在 LV 中增加而在 TA 中减少。Cox 模型多变量分析发现，入院时使用大麻可以预测 LV 中的较短保留时间（如年轻男性和安非他明），以及 TA 中一年后的大麻（如一年后可卡因和阿片类药物以及入院时 BDZ）。

结论

尽管大麻流行率仅在合法化的 LV 增加，但这与两个诊所的不良结果有关。年龄较小，这是一个已知的不良预后预测因素，可能与 LV 保留减少有关。