Mixed methods to explore factors associated with the decline of patients in the methadone maintenance treatment program in Shanghai, China

Lei Zhang,Min Zhao,Zhengyi Cai,Zhen Ning,Jiayi Bao,Xiaoduo Fan,Jingying Zhang,Jiang Du,Zhirong Zhou,Manji Hu,Amy Harrington,Daqing Shi

doi:10.1186/s12954-019-0304-8

Abstract

BackgroundThis study was to characterize the Methadone Maintenance Treatment (MMT) in Shanghai, China, and to explore factors associated with the decline of patients in MMT during 2005–2016.MethodsBoth qualitative and quantitative methods were used in this study. Based on the data from Shanghai Centers for Disease Control (CDC), we described the changes in the number of patients who received MMT, and new enrollment each year from 2005 to 2016. Focus groups were conducted with 22 patients, and in-depth interviews were conducted with 9 service providers.ResultsQuantitative data demonstrate that the number of new enrollment began to decline in 2009, and the number of patients receiving MMT began to decline in 2012. The main reasons for dropout include (1) discontinuing medication due to unknown reasons (25%), (2) criminal activities other than drug-related crimes (20%), (3) relapse to heroin use (16%), and (4) physical disease (10%). Qualitative assessment results indicate that the major reasons for the decline of patients in MMT are as follows: (1) the increase of Amphetamine-type stimulants (ATS) use in recent years, (2) limited knowledge about MMT in both patients and MMT staff, (3) complicated enrollment criteria, and (4) discrimination against drug use.ConclusionVarious reasons to explain the decline of patients in MMT in Shanghai, China, were identified. Government agencies, service providers, and other stakeholders need to work together and overcome identified barriers to support MMT programs in China.

Highlights

Opioid use disorder and other substance use disorders are major global health problems that severely impact communities and adversely affect both physical and mental health
The discrepancy between the number of registered substance users and the number of patients enrolled in Maintenance Treatment (MMT) clinics indicates low utilization of this service, the only medication-assisted treatment currently available in China
All patients meet the requirements of National guidelines for MMT of drug dependence: (1) opioid users with more than one failed attempt at drug treatment, (2) at least 20 years of age, (3) a permanent local resident or a temporary resident lived in the area where the applicable MMT clinic is located for at least 6 months with a temporary resident permit, and (4) with legal capacity of decision making

Summary

Introduction

Opioid use disorder and other substance use disorders are major global health problems that severely impact communities and adversely affect both physical and mental health. By the end of 2016, there were 789 MMT clinics in the country serving 344,254 active patients [4]. The discrepancy between the number of registered substance users and the number of patients enrolled in MMT clinics indicates low utilization of this service, the only medication-assisted treatment currently available in China. The retention of individuals in MMT programs in China is low, ranging from 30.0 to 70.3% [7]. Determining factors specific to low retention in Chinese programs could help facilitate the development and expansion of MMT services in China. This study was to characterize the Methadone Maintenance Treatment (MMT) in Shanghai, China, and to explore factors associated with the decline of patients in MMT during 2005–2016

Methods

Results

Conclusion