1984 2008 HIV AIDS Cumulative HIV cases 16

台灣愛滋病感染爆發流行 1984 - 2008 HIV AIDS § Cumulative HIV cases: 16, 748 § Cumulative AIDS cases: 5 , 1 8 3 § Cumulative AIDS deaths: 2, 199

流行傳染不同途徑 1984 -2008 2, 377 1, 761 613 705 377

美沙冬替代治療 l 使用劑量dosage 維持劑量 maintenance dose 60 -120 mg/day ? ? plasma level: 150 -200 ng/ml l 使用方式 route 口服 oral 每日監督下給藥 supervised dosing l 使用期間 duration of treatment 維持性，長期使用 ** maintenance use

美沙冬導入期 l 完成必要檢驗 l 導入劑量的決定 　目並沒有精確計算導入劑量的方式, 需要臨床調整　 　Initially start low and go slow—patient still 　 　use heroin 　Too aggressive strategy—possible 　methadone overdose

起始劑量 INDUCTION DOSING GUILDELINES

調整劑量 • Dosing adjustment ：increasing dose : – no more then 5 -10 mg/DAY , 20 -30 mg/ WEEK

穩定期劑量調整 • Dose adjustments during stabilization are usually in the 5 to 10 mg/d range – no more frequent than every 3 to 4 days (Health. Canada 2001), or 5 days (Tenore 2003) – or a 20 mg/d total increase per week (Verster and Buning 2000)

丁基原啡因Buprenorphine • Suboxone 舌下錠(內含Buprenorphine HCl/Naloxone Dihydrate, 2/0. 5及8/2 mg sublingual tablet) • Suboxone 添加Naloxone 的用意是防止被個案轉移 為注射使用, 避免不當的濫用行為, prevent diversion • 目前台灣已上市 Available in Taiwan – Suboxone 8 mg , 2 mg – Desud plus 8 mg

丁基原啡因Buprenorphine • 安全性高 safety profile • • • – 不會過量致死 – 對於心臟功能影響小 – 藥物交互作用少 成癮性低 low abuse liability 戒斷症狀輕微 mild withdrawal symptoms 引發急性戒斷症狀　precipitated withdrawal 接受度高，導入快速 easy induction 濫用問題少 fewer abuse problems, 三級管制藥品 schedule III 價格較高 higher medication cost

Effects of Buprenorphine on opioid receptor availability MRI Bup 0 mg Binding potential Bup 2 mg (Bmax/Kd) 4 Bup 16 mg 0 - Bup 32 mg D Nutt. Personal communication

Buprenorphine 替代治療 – 導入 l Induction in 3 days l Wait after the withdrawal symptoms l Dosing schedule – Short acting opioid 2+6, 8 -16, 8 -24 – Long acting opoid 0, 4, 8 -16, 8 -24