FAKTORI KOJI DEFINIŠU KVALITET ŽIVOTA U POPULACIJI ZAVISNIKA OD OPIJATA
Sažetak
Samo razumevanje faktora koji utiču na kvalitet života zavisnika od opijata može poboljšati i kvalitet terapije i njenu efikasnost. Postoji povezanost između načina lečenja i organizacije kompletne zdravstvene službe, što rezultira promenljivim kvalitetom života ovih bolesnika. Osim karakteristika same bolesti zavisnosti, na kvalitet života zavisnika mogu uticati i drugi aspekti života, kao što su demografija, socio-ekonomski status i zdravlje samog zavisnika. Svrha ovog istraživanja bila je da se utvrdi da li određene karakteristike zavisnika, sama bolest zavisnosti i način lečenja imaju prediktivni uticaj na kvalitet života opijatskih zavisnika koji su lečeni korišćenjem dvaju najčešćih pristupa.
Epidemiološko istraživanje studija preseka urađeno je 2020. godine na slučajnom uzorku od 70 opijatskih zavisnika lečenih u Univerzitetskom kliničkom centru Niš (35 zavisnika u programu održavanja metadonom i 35 zavisnika lečenih buprenorfinom). Koristeći standardizovane instrumente za merenje zdravstvenog statusa (engl. World Health Organization instruments for measuring health status – WHO EQ-5D), težine posledica zavisnosti (engl. Addiction Severity Index−ASI) i kvaliteta života (engl. standardized World Health Organization quality of life – WHOQOL), neophodne podatke prikupili smo preko intervjua „licem u lice” sa ispitanicima i to na osnovu nezavisno razvijenog upitnika na osnovu kojeg su izračunati indeksi zdravlja (EQ-5D Index), težina posledica zavisnosti i kvaliteta života (WHOQOL) (WHOQOL-BREF Index). Podaci su kategorisani uz pomoć odgovarajućih tehnika deskriptivne statistike, a grupne razlike procenjene su korišćenjem χ2 (Hi-kvadrat) testa i T-testa. Koristeći višestruku regresiju i korelaciju, izdvojili smo prediktore.
U pogledu vrednosti indeksa kvaliteta života, ne postoji značajna razlika između zavisnika koji se leče metadonom i zavisnika koji se ne leče metadonom. S druge strane, zavisnici koji se leče metadonom navode da imaju mnogo lošiji kvalitet života od zavisnika koji se ne leče metadonom. Zdravstvene navike, karakteristike socio-ekonomskog položaja ispitanika i drugi ishodi vezani za zavisnost najistaknutiji su faktori sa značajnim stepenom uticaja na kvalitet života. Efekti lečenja postaju sve manje primetni. Metadonski tretman ima prediktivni uticaj na zavisnikov pogled na život, kao i na stepen zadovoljstva (svojim psihičkim zdravljem odnosno okolinom) zavisnika. Trajanje metadonske terapije i bilo kakav prekid u nezi zavisnika dva su najvažnija indikatora. Posledice metadonske terapije, kako na sam organizam, tako i na društvo, sveukupno su blage.
Nemoguće je da se jedan prediktor računa i kao stepen i kao percepcija kvaliteta života u nizu različitih karakteristika. Broj razmotrenih aspekata prilično je velik, a implikacije koje iz toga proizilaze su složene.
Reference
Aghayan S, Amiri M, Chaman R, Khosravi A. Quality of Life in Methadone Maintenance Treated Patients in Iran. Int J High Risk Behav Addict 2015;4(4): e22275. [CrossRef] [PubMed]
Astals M, Domingo-Salvany A, Buenaventura CC, Tato J, Vazquez JM, Martín-Santos R, et al. Impact of substance dependence and dual diagnosis on the quality of life of heroin users seeking treatment. Subst Use Missus 2008; 43(5):612-32. [CrossRef] [PubMed]
Balestroni G, Bertolotti G. L'EuroQol-5D (EQ-5D): uno strumento per la misura della qualità della vita [EuroQol-5D (EQ-5D): an instrument for measuring quality of life]. Monaldi Arch Chest Dis 2012;78(3):155-9. [CrossRef] [PubMed]
Bawor M, Dennis BB, Anglin R, Steiner M, Thabane L, Samaan Z. Sex differences in outcomes of methadone maintenance treatment for opioid addiction: a systematic review protocol. Syst Rev 2014;3:45. [CrossRef] [PubMed]
Campêlo SR, Barbosa MA, Dias DR, Caixeta CC, Leles CR, et al. Association between severity of illicit drug dependence and quality of life in a psychosocial care center in BRAZIL: cross-sectional study. Health Quality Life Outcomes 2017; 15(1): 223. [CrossRef] [PubMed]
Carlsen SEL, Lunde LH, Torsheim T. Sebastiano Costa (Reviewing editor). Predictors of quality of life of patients in opioid maintenance treatment in the first year in treatment. Cogent Psychology 2019; 6:1. [CrossRef]
De Maeyer J, van Nieuwenhuizen C, Bongers IL, Broekaert E, Vanderplasschen W. Profiles of quality of life in opiate-dependent individuals after starting methadone treatment: a latent class analysis. Int J Drug Policy 2013;24(4):342-50. [CrossRef] [PubMed]
De Maeyer J, Vanderplasschen W, Camfield L, Vanheule S, Sabbe B, Broekaert E. A good quality of life under the influence of methadone: a qualitative study among opiate-dependent individuals. Int J Nurs Stud 2011;48(10):1244-57. [CrossRef] [PubMed]
Dehghan M, Mirza HK, Alaeifar S, Jazinizadeh M, Iranmanesh MH, Mohammadiakbarabadi F, et al. Quality of Life and Use of Complementary and Alternative Medicines among Narcotics Anonymous Patients: A Cross-Sectional Study in Southeast Iran. Evid Based Complement Alternat Med 2023; 2023:3003247. [CrossRef] [PubMed]
Devlin N, Parkin D, Janssen B. Methods for Analysing and Reporting EQ-5D Data [Internet]. Cham (CH): Springer; 2020. Chapter 1, An Introduction to EQ-5D Instruments and Their Applications 2020; 11(1): 1-65. [PubMed]
Evans JL, Hahn JA, Page-Shafer K, Lum PJ, Stein ES, Davidson PJ, et al. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study). J Urban Health 2003; 80(1):137–46. [CrossRef] [PubMed]
Feelemyer JP, Jarlais DCD, Arasteh K, Phillips BW, Hagan H. Changes in quality of life (WHOQOL-BREF) and addiction severity index (ASI) among participants in opioid substitution treatment (OST) in low and middle income countries: an international systematic review. Drug Alcohol Depend 2014; 134:251-8. [CrossRef] [PubMed]
Fei JTB, Yee A, Habil MHB, Danaee M. Effectiveness of Methadone Maintenance Therapy and Improvement in Quality of Life Following a Decade of Implementation. J Subst Abuse Treat 2016; 69: 50-6. [CrossRef] [PubMed]
Guillery SPE, Hellweg R, Kronenberg G, Bohr U, Kunte H, Enge S. Quality of Life in Opioid Replacement Therapy: A Naturalistic Cross-Sectional Comparison of Methadone/Levomethadone, Buprenorphine, and Diamorphine Patients. Eur Addict Res 2021;27(5):371-80. [CrossRef] [PubMed]
Huissoud T, Rousson V, Dubois-Arber F. Methadone treatments in a Swiss region, 2001-2008: a registry-based analysis. BMC Psychiatry 2012; 12:238. [CrossRef] [PubMed]
Lin CY, Chang KC, Wang JD, Lee LJ. Quality of life and its determinants for heroin addicts receiving a methadone maintenance program: Comparison with matched referents from the general population. J Formos Med Assoc 2016; 115(9):714-27. [CrossRef] [PubMed]
Marinković M, Đorđević-Jovanović L, Miljković S, Milojković B, Janjić V. Quality of life of treated opiate addicts in the methadone maintenance program and those treated with buprenorphine. Vojnosanitetski pregled 2017;74(5): 435-44. [CrossRef]
McLellan AT, Kushner H, Metzger D, Peters R, Smith I, Grissom G et al. The Fifth Edition of the Addiction Severity Index. J Subst Abuse Treat 1992; 9(3): 199-213. [CrossRef] [PubMed]
O'BrienS, Mattick RP, White J, Breen C, Kimber J, Ritter A, Lintzeris N. Maintenance pharmacotherapy for opioid dependence and SF-36 health status: a comparison with general population norms and other chronic disorders. Addict Disorder Treat 2006; 5(4): 155–64. [CrossRef]
Peak J, Goranitis I, Day E, Copello A, Freemantle N, Frew E. Predicting health-related quality of life (EQ-5D-5 L) and capability wellbeing (ICECAP-A) in the context of opiate dependence using routine clinical outcome measures: CORE-OM, LDQ and TOP. Health Qual Life Outcomes 2018;16(1):106. [CrossRef] [PubMed]
Pettersen H, Landheim A, Skeie I, Biong S, Brodahl M, Oute J, Davidson L. How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study. Subst Abuse 2019; 13:1178221819833379. [CrossRef] [PubMed]
Quyen BTT, Nguyen LT, Phuong VTV, Hoang LT. Quality of life in methadone maintenance treated patients in Long An, a southern province of Vietnam. Health Psychol Open 2020;7(2):2055102920953053. [CrossRef] [PubMed]
Sacerdote P, Franchi S, Gerra G, Leccese V, Panerai AE, Somaini L. Buprenorphine and methadone maintenance treatment of heroin addicts preserves immune function. Brain Behav Immun 2008;22(4):606-13. [CrossRef] [PubMed]
Sanders C, Egger M, Donovan J, Tallon D, Frankel S. Reporting on quality of life inrandomized controlled trials: bibliographic study. BMJ 1998; 317(7167): 1191–4. [CrossRef] [PubMed]
Smith KW, Larson MJ. Quality of life assessments by adult substance abusers receiving publicly funded treatment in Massachusetts. Am J Drug Alcohol Abuse 2003; 29(2): 323–35. [CrossRef] [PubMed]
Tang W, Han M, Huang X, Huang X, Zhang T, Tan M, et al. Analysis of quality of life and influencing factors among male drug addicts during the period of compulsory isolation detoxification. Chin J Drug Depend 2017; 26(2):126–34.
The World Health Organization.WHOQOL-BREF : introduction, administration, scoring and generic version of the assessment : field trial version, December 1996, 16 June 2012.
Tracy EM, Laudet AB, Min MO, Kim H, Brown S, Jun MK, Singer L. Prospective patterns and correlates of quality of life among women in substance abuse treatment. Drug Alcohol Depend 2012;124(3):242-9. [CrossRef] [PubMed]
Tun S, Balasingam V, Singh DS (2022) Factors associated with quality of life (QOL) scores among methadone patients in Myanmar. PLOS Glob Public Health 2(8): e0000469. [CrossRef] [PubMed]
Wang PW, Lin HC, Yen CN, Yeh YC, Hsu CY, Chung KS, et al. Comparison of outcomes after 3-month methadone maintenance treatment between heroin users with and without HIV infection: a 3-month follow-up study. Harm Reduct J 2015; 12:13. [CrossRef] [PubMed]
Zhang X, Luo J, Chen Q, Zhu Y, Cui W, Chen L. Analysis of the quality of life and influencing factors of patients receiving methadone maintenance treatment.J Kumming Med Univ 2020; 34: 43–6. [PubMed]
Zielinski L, Bhatt M, Sanger N, Plater C, Worster A, Varenbut M, et al. Association between cannabis use and methadone maintenance treatment outcomes: an investigation into sex differences. Biol Sex Differ 2017; 8:8. [CrossRef] [PubMed]
