Bidirectional relationships between retention and health-related quality of life in Chinese mainland patients receiving methadone maintenance treatment.

Kaina Zhou,Duolao Wang,Xiaoli Wei,Mengmeng Hao,Peifeng Liang,Lijuan You,Hengxin Li,Guihua Zhuang,Lingling Kou,Xiaomei Li,Juan Yin,Bernard Le Foll

doi:10.1371/journal.pone.0179009

Abstract

This study aimed to explore the bidirectional relationships between retention and health-related quality of life (HRQoL) in patients from mainland China receiving methadone maintenance treatment (MMT). This prospective cohort study recruited 1,212 eligible MMT patients from the two largest MMT clinics (one privately and another publicly funded) in Xi’an. This study started in March 2012 with a 2-year follow-up until March 2014. Retention was assessed by repeated terminations, past treatment duration, premature terminations, and follow-up treatment duration. HRQoL was evaluated using the Chinese (simple) short-form 36 health survey version 2 (SF-36v2) and the quality of life scale for drug addicts (QOL-DAv2.0). Linear and Cox regression analyses were used to explore relationships between retention and HRQoL. A general linear model was used to further examine the global effect of past treatment duration on HRQoL. Multivariate analyses showed that repeated terminations had no significant impact on HRQoL scores in MMT patients; however, past treatment time (year) influenced the SF-36v2PCS (P = 0.004): treatment for ≥4 years showed a lower SF-36v2PCS score (regression coefficient: -2.39; 95% confidence interval [CI]: -3.80, -0.97; P = 0.001) than treatment for <1 year. In addition, patients with an SF-36v2PCS score > 49 (hazard ratio: 0.83; 95% CI: 0.69, 0.98; P = 0.03) were 17% less likely to terminate MMT than those with scores of ≤49. In conclusion, retention and HRQoL tended to have a bidirectional relationship, which should be considered in the development of retention and health-management programs for patients with MMT.

Highlights

Methadone maintenance treatment (MMT) is a harm-reduction program for people with opioid dependence; it involves the use of methadone as a synthetic agent to block the brain receptors affected by heroin and other opiates [1]
A large body of evidence indicates that MMT can reduce drug addiction, drugrelated harms, risk behaviors, crimes, and transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) [4,5]
To further our previous study [21], the present study aimed to identify bidirectional relationships between retention and health-related quality of life (HRQoL) in patients from mainland China receiving MMT

Summary

Introduction

Methadone maintenance treatment (MMT) is a harm-reduction program for people with opioid dependence; it involves the use of methadone as a synthetic agent to block the brain receptors affected by heroin and other opiates [1]. In China, MMT was initiated as a pilot program in 8 clinics assisting 1,029 drug users in 2004 and subsequently expanded to 761 clinics assisting. Drug users receiving MMT show markedly improved personal relationships, enhanced social productivities, and better health-related quality of life (HRQoL) [6,7,8,9]. Given that MMT involves drug substitution and long-term administration, retention is the main factor that directly influences the treatment outcomes and a major indicator for the therapeutic effects of the program [10,11]

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Results

Conclusion