背景與目的：新型冠狀病毒肺炎（COVID-19）疫情對全球帶來巨大衝擊，特別是針對特定弱勢族群，包括接受美沙冬替代療法（Methadone Maintenance Treatment, MMT）的海洛因藥癮者。由於臺灣美沙冬替代療法服務模式主要採每日至指定醫療院所服藥，疫情期間政府與醫療院所實施的防疫措施，包含：醫療資源降載、移動管制等，這些防疫的必要措施可能影響到美沙冬替代療法之連續性，導致藥癮者中斷戒癮治療或復發。本研究旨在探討新冠疫情對美沙冬替代療法服務連續性的影響，深入瞭解醫療院所美沙冬替代治療服務提供者與服務使用者雙方在疫情期間實際面臨的挑戰與採取的應對策略。
方法：本研究屬質性研究，使用衛生福利部心理健康司2015至2023年「替代治療執行進度」官方統計，觀察疫情前後服務利用之概況與變化，選取8家給藥醫療院所，包含全國6家最大之美沙冬給藥院所，以及2家位於臺灣南部之醫學中心與精神專科醫院之服務提供者與使用者進行質性深度訪談，採立意與滾雪球方式取樣。本研究於2024年10月至2025年7月間，共訪談12位服務提供者（含主管、護理師、個管師），訪談過程全程錄音並轉寫為逐字稿，確保資料完整與真實性。資料分析採用主題分析法，並以 NVivo軟體進行樹狀節點編碼，再依據預設之主題分析架構呈現受訪者在疫情期間接受美沙冬替代療法之經驗與觀點。
結果：受訪之8家醫療院所在2020年至2022年間，美沙冬替代療法服務人次皆呈現下滑趨勢，甚至於疫情後期（2022-2023年），多數醫療院所服務量仍未恢復至疫情前規模。而在疫情期間，受訪醫療院所為維持美沙冬替代服務連續性，展現不同的因應彈性，透過時間分流、戶外取藥、車來速及居家送藥等彈性給藥模式，並轉型遠距視訊看診或穩定個案免到院回診，以降低染疫風險。研究發現，藥癮者服藥中斷受染疫恐懼、異地就業、隔離限制及轉向院外購買丁基原啡因等因素影響；而維持服藥的動力則來自避免戒斷症狀的生理依賴、疫情期間海洛因價昂取得不易，以及醫護人員的主動追蹤與跨部門媒合。
結論：本研究發現我國美沙冬替代治療在重大公共衛生危機中展現應變能力，嘗試在防疫與治療間取得平衡。然而，現行《管制藥品管理條例》對管制藥品給藥模式的嚴格限制，以及缺乏全國一致性的緊急應變指引，仍是主要的制度性限制。未來建議政府應將美沙冬替代治療服務連續性應變指引納入國家公共衛生防疫計畫。此外，針對病況穩定、治療依從性高的個案，建議主管機關積極研議更具彈性之給藥模式，例如：結合遠距視訊監督的機制，以在維持管制安全的前提下，提升治療的可近性與連續性，應對未來類似的突發危機。

The COVID-19 pandemic disproportionately affected vulnerable populations, including people with heroin dependence receiving Methadone Maintenance Treatment (MMT). In Taiwan, MMT is delivered through a highly regulated system requiring daily supervised dosing at designated medical institutions, which faced substantial challenges during the pandemic. Infection-control measures such as healthcare service downscaling and mobility restrictions were necessary to contain viral transmission but risked disrupting treatment continuity and increasing relapse. This qualitative study examined the impact of COVID-19 on the continuity of MMT services in Taiwan using official substitution treatment statistics (2015–2023) and in-depth interviews conducted at eight methadone-dispensing institutions. Results showed sustained declines in service volume during 2020–2022, with incomplete recovery in 2022–2023. Healthcare facilities adopted adaptive strategies including time-slot scheduling, outdoor and drive-through dispensing, home delivery of methadone, and telemedicine consultations. Treatment interruption was driven by infection fears, mobility restrictions, and non-medical buprenorphine use, whereas adherence was supported by withdrawal avoidance, reduced heroin availability, and proactive healthcare outreach. The findings indicate that Taiwan’s MMT system demonstrated resilience during a public health crisis but highlight the need for nationally standardized emergency guidelines and more flexible, tele-supervised dispensing models to ensure service continuity in future emergencies.

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