Polysubstance Use among Patients Enrolling in Methadone Maintenance Treatment Program in a Vietnam Province with Drug-Driven HIV Epidemic.

Tuan Anh Le,Tung Hoang Tran,Duyen T T Pham,Carl A Latkin,Roger C M Ho,Cyrus S H Ho,Quan Hoang Vuong,Ninh Hai Thi Tran,Bach Xuan Tran,Cuong Tat Nguyen,Tung Thanh Tran,Travis T C Quek,Chi Linh Hoang,Giang Thu Vu

doi:10.3390/ijerph16183277

Abstract

Methadone maintenance treatment (MMT) has been scaled up significantly in recent years. This study aimed to investigate the pattern of polysubstance use in 395 MMT patients and its contextualized associated factors. A cross-sectional study was performed in three outpatient MMT clinics in Nam Dinh Province. Multivariate Poisson regression was used to identify factors associated with polysubstance use status. The mean MMT duration and the current MMT dose was 3.3 years and 69.2 mg, respectively. Among participants, 24.8% reported daily alcohol use, 68.6% smoked regularly, and 6% used illicit drugs. Peer pressure and MMT suboptimal adherence were found to associate with continual usage of drugs (47.8%). Participants who lived with a spouse/partner, were self-employed, and smoked were more likely to drink alcohol. Those who drink were also more likely to smoke, and vice versa. Recommendations for policymakers include community-based education and promotional programs aiming to decrease substance usage in the community as well as encouraging and supporting the private health sector in establishing private MMT services and clinics. Further longitudinal studies on polysubstance usage among MMT patients should also be conducted.

Highlights

The Vietnamese Government estimates the number of people who inject drugs (PWIDs) in the country to be around 271,000 [1], of which 85% are heroin users
While buprenorphine has been recently piloted for its feasibility and cost-effectiveness, methadone maintenance treatment (MMT) has been found to be one of the most cost-effective methods to reduce the use of opioids among those enrolled in the program in a number of countries globally [4,5,6,7,8]
Our finding indicates that tobacco is the most common (81%) substance used among patients participating in the MMT program

Summary

Introduction

The Vietnamese Government estimates the number of people who inject drugs (PWIDs) in the country to be around 271,000 [1], of which 85% are heroin users. This population has been regarded as the key at-risk population for HIV infection in Vietnam, with HIV prevalence reported to be at 14%, higher than that of other at-risk populations such as sex workers (3.7%) and men who have sex with men (12.2%) [2]. Another report indicated that PWIDs accounted for 60% of newly HIV-infected cases in Vietnam [3] Interventions targeting this group would benefit the fight against the HIV/AIDS epidemic in the country. By March 2017, 51,318 drug users had been provided MMT by 280 methadone clinics in 63 cities and all provinces of Vietnam [8]

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Discussion

Conclusion