Methadone Maintenance Treatment Clients Research Articles

Risk factors for poor treatment outcomes among opioid-dependent clients taking methadone in Mombasa, Kenya.

Background: The Methadone Maintenance Treatment (MMT) program has been proven to be beneficial in reducing illicit opioid use, increasing access to and retention of HIV treatment and other therapies, and reducing HIV transmission, and other drug-related morbidities and mortalities. However, determinants of treatment retention and outcomes for opioid-dependent persons accessing MMT in Kenya are limited. We sought to identify factors contributing to poor treatment outcomes among opioid-dependent persons enrolled in the Mombasa MMT program, between 2017 and 2019. Method: We conducted a retrospective records review for opioid-dependent persons receiving Methadone treatment in the Kisauni MAT clinic enrolled during 2017-2019. We defined poor clinical or health-related treatment outcome as any client Lost-To-Follow-Up (LTFU), turned HIV or Viral hepatitis positive, and/or missed two or more antiretroviral therapy (ART) appointments intake during MMT. Variables abstracted from clinical and pharmacological MMT service delivery tools included socio-demographic characteristics, clinical history, risk factors, and MMT outcomes. Data were analyzed using Epi Info7. We calculated Prevalence Odds Ratios (POR) and 95% Confidence Intervals (CI) to identify factors associated with adverse health outcomes. Results: Of the total 443 eligible records, the mean age was 37years (SD ± 7.2) and males comprised 90.7%. The majority of females clients, 79.1% (34/43), were aged ≤35years, 7.0% (3/43) had no education, 32.6% (14/43) were employed, 39.5% (17/43) were HIV positive and 18.6% (8/43) were HCV-positive. Overall, adverse treatment outcomes were at 27.5% (122/443), namely: LTFU at 22.8% (101/443), new HIV cases at 1.0% (4/391), HCV at 1.2% (5/405), and Hepatitis B Virus (HBV) at 1.2% (5/411), and 1.1% (5/443) died. Of HIV-infected clients linked to Comprehensive Care Clinic (CCC), 3.6% (2/56) defaulted from ART, and 25% (2/8) had detectable Viral Load of those retested. Lack of formal education (POR: 2.7, 95% CI: 1.3-5.7), unemployment (POR: 2.4, 95% CI: 1.4-4.0), and being a Non-Injector (POR: 1.7, 95% CI: 1.0-2.9) were negatively associated with treatment retention. Conclusion: Females were younger, and more educated with higher HIV and HCV prevalence. Being a Non-injector, unemployment, and lack of formal education may increase the likelihood of poor treatment outcomes among MMT clients. Closer monitoring of MMT clients with these characteristics is recommended with the integration of CCC into MMT services.

Complimentary Addictions: Pharmaceutical Experimentalism and the Problem of Recovery in Baltimore

ABSTRACT In Baltimore, clients in methadone maintenance treatment (MMT) experiment with prescription medicine and in doing so face new risks of noncompliance as they tread this blurry line between medical and illegal. This can potentially lead to suspension from drug treatment programs, resulting in clients finding the next most suitable treatment center to enroll into. I argue that the close interaction between drug treatment centers and illegal markets results in new pharmaceutical dependencies, forms of self-care as well as suspicions toward, but also among clients, about their intentions to recover.

Exploring factors jointly associated with recurrent relapse and dropout of methadone maintenance treatment clients in Guangdong, China: A retrospective cohort study

BackgroundClients receiving methadone maintenance treatment (MMT) may experience multiple relapses, which may lead to dropout. However, previous studies mostly only explored the influencing factors of relapse or dropout separately. In this study, we investigated the influencing factors jointly associated with both recurrent relapse and dropout. MethodsThis study was conducted in 16 MMT clinics in Guangdong, China. Data on the clients’ demographic characteristics; drug-related behavior; HIV, HCV, and urine morphine test results; and daily methadone doses were collected. The outcomes were time to recurrent relapse and time to dropout. A joint frailty model was used to explore factors jointly associated with recurrent relapse and dropout. The hazard ratios (HRs) of the covariates in the multivariable model were adjusted, with HR > 1 indicating a faster time to recurrent relapse and dropout. ResultsAmong 1539 clients, 39.5% had ≥ 2 relapse events, and 90.8% of the clients dropped out. A high attendance rate was protective for recurrent relapse (HR50–80%=0.63, 95% CI: 0.51, 0.79; HR>80%=0.35, 95% CI: 0.28, 0.44) and dropout (HR50–80%=0.56, 95% CI: 0.47, 0.68; HR>80%=0.27, 95% CI: 0.23, 0.33). Being married (HR=0.80, 95% CI: 0.67, 0.96), having a fair relationship with family (HR=0.79, 95% CI: 0.67, 0.93) and drug injection (HR=0.80, 95% CI: 0.67, 0.96) were also protective for recurrent relapse. Female (HR=0.64, 95% CI: 0.50, 0.82) and a high methadone dose (≥60 ml/day; HR=0.79, 95% CI: 0.65, 0.96) were protective for dropout, and a longer traveling time to the clinic (>60 min; HR=1.59, 95% CI: 1.20, 2.10) was associated with an increased risk of dropout. ConclusionsIt is common for clients to experience recurrent relapse and dropout. The findings suggest that MMT clinics should provide holistic interventions and appropriate methadone doses for clients to improve treatment compliance.

Comparison of Psychopathologic Characteristics between Individuals Undergoing Methadone Maintenance Treatment, Opioid Dependents, and Control Group.

Methadone maintenance treatment (MMT) can theoretically reduce the psychosocial harms of opioid dependency. The increasing number of MMT clinics in Iran during the last two decades was not accompanied by a reduction in addiction rates. Therefore, this study was conducted to compare the psychopathological characteristics of individuals on MMT, opioid dependents, and a control group in the Iranian population. This cross-sectional study was conducted in Mashhad to evaluate the psychopathological profile of 99 participants (33 opioid-dependent individuals [ODI], 33 MMT clients, and 33 controls) using the Symptom Checklist-90-Revised (SCL-90-R) questionnaire and demographic form. Parametric and non-parametric tests were used to compare the mean score of symptoms between the three groups. The Spearman correlation test was used to test the correlation of psychological features with age and dependency duration. There was no significant difference between MMT clients and ODI regarding the Global Severity Index (GSI) and nine items of the SCL-90-R questionnaire. However, a significant difference was found between the controls and two other groups (P<0.001). Paranoid ideation in the ODI was more frequent compared to MMT clients significantly (P=0.015). Psychological characteristics had a direct correlation with dependency duration and an inverse correlation with age (P<0.05). Psychopathologic features observed in the dependent patients and MMT clients were significantly higher than in the control group. It seems that the psychopathology profile in MMT clients was not better than dependent individuals in Iran.

Feasibility of a Brief Intervention to Decrease Harmful Alcohol Use Among Methadone Maintenance Treatment Clients in Shanghai: A Randomized Controlled Trial.

In this study, we aimed to examine the prevalence of alcohol consumption among methadone maintenance treatment (MMT) clients in Shanghai and to determine whether a brief intervention (BI) affects drinking among them. A total of 837 clients from 14 local MMT clinics were invited to complete the Alcohol Use Disorders Identification Test (AUDIT). One hundred one were included in the study and randomly assigned to the BI group or the control group. Clients in the BI group received a BI and general health education, whereas clients in the control group received the general health education only. Baseline and postintervention assessments were conducted by using the AUDIT, the Drinking Attitude Questionnaire, the Depression Module of the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the General Well-Being Schedule. Two hundred fifty-nine (30.9%) reported drinking during the last year, and 103 (12.3%) met the criteria for harmful use. At the 3-month follow-up, the AUDIT scores of the 2 groups were significantly decreased, and the time effect was statistically significant ( F = 6.224, P = 0.018), but there was no group difference in AUDIT scores ( F = 1.953, P = 0.172). Both groups had a main time effect of time on the improvement of depression ( F = 8.044, P = 0.008), anxiety ( F = 9.650, P = 0.004), and general well-being ( F = 5.056, P = 0.033). However, there was no statistical difference between the 2 groups ( P > 0.05), and no statistical difference in the time ( F = 1.738, P = 0.198) and group ( F = 0.658, P = 0.424) effect of drinking attitude. Alcohol consumption is common among MMT clients in China. Brief intervention, in its current form, could not effectively help them reduce their alcohol consumption.

A feasibility study of a peer-facilitated physical activity intervention in methadone maintenance

PurposeWhile methadone maintenance treatment (MMT) has been effective in improving opioid use outcomes, most patients continue to engage in unhealthy lifestyles that lead to significant mental and physical health consequences. Interventions targeting increases in physical activity (PA) in MMT patients could have a significant impact on reducing the overall morbidity in these individuals. The purpose of this study was to assess acceptability and feasibility of a 12-week peer-facilitated PA intervention for MMT patients called TREC (Transforming Recovery with Exercise and Community). MethodWe developed and then pilot-tested TREC in 26 low-active MMT clients (73% female; mean age = 41.2 years). TREC included: 1) an orientation session and intervention materials, 2) weekly PA discussion groups led by trained MMT clients, 3) peer-led walking groups and 4) a Fitbit activity tracker to facilitate self-monitoring of PA. ResultsParticipants attended 63% of eligible TREC sessions. Sixty-nine percent of the sample wore the Fitbit for at least 6 weeks (of the 12-week intervention). Participants reported that they enjoyed the group walks and that it was helpful to have a peer-facilitated PA group. There were small-to-moderate effect sizes for increases in PA, positive affect, and benefits of PA, and decreases in illicit opioid use and barriers to PA. No changes in depression, anxiety, and negative affect were observed from baseline to the end of the 12-week intervention. ConclusionIndicators of feasibility and acceptability suggest that a peer-facilitated PA intervention can be incorporated in the context of MMT. Low active, opioid dependent clients showed increases in PA during the 12-week intervention. A future randomized clinical trial is necessary to determine the efficacy of TREC on long-term maintenance of PA and ancillary mental health and substance use outcomes.

Troponin, A Predictor of Mortality in Methadone Exposure: An Observational Prospective Study.

BackgroundMethadone poisoning/overdose is a global public health problem. We aimed to determine whether methadone poisoning increased cardiac troponin and whether high‐sensitivity cardiac troponin I (hs‐cTnI) levels predicted the need for intensive care unit admission, intubation, and mortality.Methods and ResultsThis observational, prospective single‐center study was done at Loghman‐Hakim Hospital (Tehran, Iran) from June 2018 until February 2019. Patients aged >14 years admitted with a diagnosis of methadone exposure were included. Patients were excluded if they had coexisting conditions associated with elevated hs‐cTnI levels. An ECG and hs‐cTnI levels were obtained on emergency department presentation. Patients were followed up on their need for intubation, intensive care unit admission, and in‐hospital mortality. Of 245 included patients (186 [75.9%] men; median age, 33 years), most referred to loss of consciousness (210 cases, 89%). Nineteen (7.7%) patients had hs‐cTnI levels of >0.1 ng/mL (positive), and 41 (16.7%) had borderline levels of 0.019 to 0.1 ng/mL. Twenty‐three (9.3%) cases were admitted to the intensive care unit, 21 (8.5%) needed intubation, and 5 (2%) died during hospitalization. An hs‐cTnI cutoff value of 0.019 ng/mL independently predicted mortality. For optimal concomitant sensitivity and specificity, receiver operating characteristic curve analysis was conducted and showed that hs‐cTnI had an independent significant association with mortality, with a cutoff value of 0.0365 ng/mL (odds ratio, 38.1; 95% CI, 2.3–641.9; P<0.001).ConclusionsMethadone exposure/toxicity is a newly identified cause of elevated hs‐cTnI. Values >0.019 ng/mL, and particularly >0.0365 ng/mL, of hs‐cTnI predicted mortality in our sample. Future studies should measure troponin levels in methadone maintenance treatment clients to assess the risk of myocardial injury from long‐term exposure.

Higher methadone dose reduces risky drug injecting behaviours among methadone clients in Myanmar

BackgroundHIV prevalence rate among people who inject drugs (PWIDs) in Myanmar is marginally high (34.9%). HIV transmission can be reduced and prevented through harm reduction programs such as methadone maintenance treatment (MMT) and needle syringe exchange program (NSEP). We sought to determine the relationship between methadone dose and injecting behaviours among clients enrolled in the MMT program in Myanmar. MethodA total of 210 MMT clients, who had a minimum of six-month methadone treatment history, were recruited from five cities through stratified random sampling for this cross-sectional study. A semi-structured questionnaire with the timeline flow back (TLFB) scale was administered. Respondents were also screened for illicit drug use. ResultsAlmost two-thirds (63.5%, n=132) received less than or equal to 80mg/day of methadone dose, and 36.5% (n=76) received more than 80mg of methadone daily, while the sample average daily methadone dose in this study was 83mg (ranging from 20mg to 300mg per day). The results indicated that methadone dose was associated with having HIV infection, antiretroviral therapy (ART) and tuberculosis (TB) treatment history, heroin injection history in the last 30 days, needle sharing history, addiction severity on employment, as well as THC (cannabis) and benzodiazepine use history (p<0.05). In addition, those who received a high methadone dose (more than 80mg/day) reduced their heroin injection use by 4 times compared to heroin injection frequency of respondents on low methadone dose (injection IRR=0.0029 vs. 0.0118, p=0.0000). Meanwhile, those who had HIV on high methadone dose were 2.6 times more likely to report reduction in risky injecting behaviours compared to low methadone dose. ConclusionA higher dose of methadone on prescription (more than 80mg/day) seems to reduce risky HIV injecting behaviours among both HIV negative and positive clients in MMT programs in Myanmar.

Methamphetamine use and misconceptions among primary and private Methadone Maintenance Treatment (MMT) program attendees in Klang Valley, Malaysia

ABSTRACT Background: Treatment-seeking opiate dependents in Methadone Maintenance Treatment (MMT) programs are predisposed to methamphetamine use. This study sought to determine the prevalence, reasons, and perceptions toward methamphetamine use among clients in primary and private MMT programs in Klang Valley (Malaysia). Method: 231 methadone users (n = 153 primary vs. n = 78 private clients) with current methamphetamine use history participated in this cross-sectional study. Results: Most participants were male (96%, n = 221/231), with the majority being Malay (84%, n = 194/231). More than two-thirds (71%, n = 164/231) initiated methamphetamine before MMT enrollment. Those who initiated methamphetamine after MMT enrollment had higher odds of reporting methamphetamine use in the last 7 days (OR: 2.28: 1.05–4.95; p <.033) and 30 days (OR: 2.49: 1.38–4.48; p <.002), than those who have initiated methamphetamine before joining MMT program. Compared to primary clients, private clients had higher odds of reporting opiate use in the last 30 days (OR: 1.86: 1.00–3.44; p <.048). Most participants used methamphetamine to increase work performance; the majority of participants believed that they can control methamphetamine use and that it was non-addictive, and safer when taken with methadone. Conclusion: Methamphetamine use appeared prevalent among MMT clients and the lack of information regarding the dangers of methamphetamine may be a probable cause.

The Association between Living Status Transitions, Behavior Changes and Family Relationship Improvement among Methadone Maintenance Treatment Participants in Guangdong, China.

The quality of family relationships is important for individual and family well-being. Improving family relationships is also an important goal in methadone maintenance treatment (MMT). Little is known about factors associated with the improvement of family relationships among MMT clients. This study aimed to identify factors associated with family relationship improvement in MMT. We retrospectively analyzed existing data from 2006 to 2014 at 15 MMT clinics in Guangdong, China, including 2171 subjects with 4691 follow-ups. Generalized estimating equations were used to investigate the association between living status transitions, behavior changes and family relationship improvement, with covariates controlled for. Family relationship improvement was found in 23.1% of all follow-up intervals. Participants who began living with family, living on a regular wage, and gained employment were more likely to have improved family relationships. The quality of family relationships also improved among participants who ceased contact with drug-addicted fellows, ceased drug use, and those who were sexually active. These results suggest that improvement in living status, positive changes in drug use, and sexual activity are associated with family relationship improvement and corresponding interventions may be developed to facilitate clients’ recovery.

Comparison of coping strategies and emotion regulation tendencies among opium users, methadone maintenance treatment clients and normal individuals

Comparison of coping strategies and emotion regulation tendencies among opium users, methadone maintenance treatment clients and normal individuals

Hepatitis C Virus Treatment Status and Barriers among Patients in Methadone Maintenance Treatment Clinics in Guangdong Province, China: A Cross-Sectional, Observational Study.

We aimed to evaluate the status and barriers related to hepatitis C virus (HCV) treatment among Chinese methadone maintenance treatment (MMT) clients, and the willingness and barriers of patients to accept directly observed treatment (DOT) service and oral direct-acting antivirals (DAAs). We conducted a cross-sectional survey from July to October 2017 in Guangdong Province, China, involving 678 HCV antibody-positive MMT patients. If they reported being infected with HCV, then their HCV treatment experience, willingness to use DOT and DAAs, along with any barriers, were collected. Logistic regression analysis was used to identify the correlates of initiating HCV treatment. Among those reporting HCV infection (54%, 366/678), 39% (144/366) initiated treatment; however, 38% (55/144) interrupted and 55% (79/135) delayed treatment for 15 months. Seventy-five percent (273/366) and 53% (195/366) were willing to use DOT and DAAs, respectively. Unaffordable medical costs and insignificant symptoms were the major barriers to HCV treatment and accepting DOT or DAAs. The lack of a stable residence, being a woman, and having ever injected drugs were all associated with a low probability of initiating treatment (p < 0.05). This study highlights a limited uptake of HCV treatment among MMT patients, and a need to strengthen the popularity of DOT and DAAs and integrate them into Chinese MMT clinics.

Prevalence of Amphetamine-Type Stimulants (ATS) use among clients in primary and private Methadone Maintenance Treatment (MMT) program in Kuantan, Malaysia

ABSTRACTIntroduction: The use of amphetamine-type stimulants (ATS) is becoming prevalent among clients in Methadone Maintenance Treatment (MMT) program. This study aims to determine the prevalence of, and reasons for, ATS use among clients enrolled in MMT programs in Kuantan, Malaysia.Method: A total of 237 regular methadone users with current ATS use history were recruited from two MMT settings (primary and private facilities) for this cross-sectional study.Results: Most of the subjects were male (97%, n = 230/237), majority Malays (96%, n = 228/237). The mean age of respondents was 37.7 years (SD = 8.5), and their mean methadone dose was 52.8mg/daily. Our results showed that ATS was commonly used for increasing energy, heighten euphoria, reduce methadone dependence and its side-effects, overcome psychological problems, and as a sex stimulant. The commonly used ATS over the last 30 days during treatment were amphetamine (79%, n = 188/237), methamphetamine (64%, n = 151/237), and opiate (37%, n = 88/237). Results from Chi-square analysis showed clients in private MMT program have higher odds of using opiates (OR: 4.1: 2.37–7.27; p < .0001), and methamphetamine (OR: 1.10: 1.15–3.44; p < .013) in the last 30 days than clients in the primary MMT program.Conclusion: Our findings indicate the high prevalence of ATS use among MMT clients.

Perceptions of Problem Gambling Among Methadone Maintenance Treatment Clients and Counsellors

Problem gambling is highly prevalent and rarely treated among clients who attend methadone maintenance treatment programs (MMTPs). Compared with those of the general population, rates of gambling disorder have been found to be elevated among individuals receiving methadone maintenance treatment. Our study aims were to (a) develop a clearer understanding of the gambling experience of clients and counsellors at a methadone clinic and (b) gain insight into the current treatment options and obstacles to treatment in the clinic. Semi-structured interviews focusing on gambling issues were conducted with 8 clients and 8 counsellors at an MMTP located in an urban area. Participants were asked questions to gain an understanding about their perspectives on, treatment options for, and treatment barriers to problem gambling in the clinic. Data were coded by 4 investigators by using a constant comparison, open coding approach. The findings revealed important differences between clients and counsellors: Opinions differed on the definition of problem gambling, obstacles to treatment, and optimal treatment settings. Clients and counsellors also agreed on some elements, including the negative impact that problem gambling can have on recovery from substance use. This examination of responses of counsellors and client feedback provides a useful mechanism to better understand problem gambling in MMTPs. In addition, the findings have important clinical implications, including a need for more effective screening and treatment in MMTPs and to provide substance use counsellors with training related to problem gambling.RésuméLe jeu compulsif est hautement répandu et rarement traité parmi les clients qui suivent un programme de traitement d’entretien à la méthadone. Comparés à ceux de la population en général, les taux de jeu pathologique ont jugé élevés chez les personnes qui suivent un tel traitement. Les objectifs de notre étude étaient de deux ordres : a) mieux comprendre l’expérience de jeu des clients et les connaissances en cette matière des conseillers d’une clinique de traitement à la méthadone, et b) avoir une meilleure compréhension des options de traitement actuelles et des obstacles au traitement en clinique. Des entretiens semi-structurés portant sur les problèmes de jeu ont été menés auprès de 8 clients et de 8 conseillers dans un centre de traitement, situé en zone urbaine. On a posé des questions aux participants pour mieux comprendre leurs points de vue sur les options et les obstacles au traitement contre le jeu problématique à la clinique. Les données ont été codées par quatre chercheurs en utilisant une approche de codification ouverte à comparaison constante. Les résultats ont révélé des différences importantes entre les clients et les conseillers : les opinions divergeaient quant à la définition du jeu problématique, les obstacles au traitement et les paramètres de traitement optimaux. Les clients et les conseillers ont par ailleurs été d’accord sur certains éléments, notamment l’impact négatif que le jeu problématique peut avoir sur le rétablissement d’une consommation abusive. L’examen des réponses des conseillers et des commentaires des clients constitue un mécanisme efficace pour mieux comprendre le jeu problématique dans les programmes de traitement d’entretien à la méthadone. De plus, les résultats ont d’importantes répercussions cliniques, notamment la nécessité d’un dépistage et d’un traitement d’entretien à la méthadone plus efficaces et d’une formation sur le jeu problématique pour les conseillers en toxicomanie.

Influence of social network on drug use among clients of methadone maintenance treatment centers in Kunming, China.

AimsTo examine drug use behavior of clients attending Methadone Maintenance Treatment (MMT) programs and its relationship with the clients’ social network characteristics.DesignCross-sectional study.SettingFour MMT clinics in Kunming, Yunnan province, China.Participants324 consecutive MMT clients.MeasurementsA structured, self-completed questionnaire on background characteristics and existing social network. Current drug use was assessed by urine test for opiate metabolites.AnalysisThe association between client's social network characteristics and their own current drug use behavior is analysed using multiple logistic regression adjusting for socio-demographic characteristics. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are obtained to give the strength of the associations.FindingsMMT clients were more likely to concurrently use heroin while attending MMT if their social network had any of the following characteristics: more than half of the members were older than them (AOR = 1.03, 95% CI = 1.00,1.06), any member had a high level of influence on them (AOR = 6.47, 95% CI = 2.86,14.65) and any member joined them in using drugs (AOR = 1.94, 95% CI = 1.04,3.63). Having a social network member who could provide emotional support (AOR = 0.11, 95% CI = 0.03,0.35), having a spouse and/or child in their social network (AOR = 0.44, 95% CI = 0.24,0.81) and having a social network member with a high level of closeness (AOR = 0.28, 95% CI = 0.09,0.90) were associated with a decreased odds of heroin use.ConclusionSocial networks who could provide MMT clients with emotional support and a close relationship were significant factors for reducing the risk of concurrent drug use among clients attending MMT clinics in Kunming, China. Behavioral interventions should address the role of family and social network members in providing support to these clients.

New psychoactive substances abuse among patients with access to methadone maintenance treatment in Jiangsu province: a case-control study

Objective: To explore the reasons and factors associated with new psychoactive substances abuse among patients with access to methadone maintenance treatment (MMT). Methods: A well-developed questionnaire and urine tests were used to collect information about demographic characteristics, condition of MMT and drug abuse, family and social support of MMT clients. A 1∶1 matched case-control study was conducted, and conditional logistic regression model was used to identify factors associated with new psychoactive substances abuse. Results: A total of 212 (106 pairs) clients receiving MMT were recruited, and most of them were males (78.3%, 166/212), married or cohabitant (48.6%, 103/212) and unemployed (63.2%, 134/212). The average age of the clients was (45.1±7.2) years. The main types of abused new psychoactive substances were benzodiazepine (62.3%, 66/106) and methamphetamine (39.6%, 42/106). The proportion of abusing multi new psychoactive substances was 8.5% (9/106). Results from multivariate conditional logistic regression analysis indicated that using opioid drug during the past 6 months of MMT treatment might increase the risk of abusing new psychoactive substances (OR=3.25, 95%CI: 1.35-7.79), benzodiazepine (OR=3.25, 95%CI: 1.11- 9.47) and methamphetamine (OR=13.31, 95%CI: 1.12-158.01). Moreover, MMT for more than9 years reduced the risk of abuse of new psychoactive substances (OR=0.03, 95%CI: 0.01-0.21), benzodiazepine (OR=0.02, 95%CI: 0.00-0.36) and methamphetamine (OR=0.02, 95%CI: 0.00-0.69). Conclusion: Less new psychoactive substances abuse might be associated with longer duration of MMT treatment. And inappropriate support from family and friends might increase the risk of abusing new psychoactive substances in MMT clients, especially in clients who used opioid.

Family Related Factors and Concurrent Heroin Use in Methadone Maintenance Treatment in China

ABSTRACTBackground: The use of heroin during Methadone Maintenance Treatment (MMT) is a challenging problem that contributes to poor treatment outcomes. Families may play an important role in addressing concurrent heroin use during MMT, especially in collectivist societies such as China. Objectives: In this study, we explored the relationship between family-related factors and concurrent heroin use during MMT in China. Methods: This study was conducted at 68 MMT clinics in five provinces of China. There were 2,446 MMT clients in the analysis. Demographic information, MMT dosage, family members' heroin use status, family support of MMT, family problem, and self-reported heroin use were collected in a cross-sectional survey. The most recent urinalysis of opiate use was obtained from clinical records. Results: Of the 2,446 participants, 533 (21.79%) self-reported heroin use in the previous seven days or had a positive urine morphine test result in the clinic record. Participants whose family member[s] used heroin were 1.59 times (95% CI: 1.17, 2.15) more likely to use concurrently during treatment. Those with family members who totally support them on the MMT were less likely to use (AOR: 0.75, 95% CI: 0.60, 0.94). Having more family problems was positively associated with concurrent heroin use (AOR: 2.01, 95% CI: 1.03, 3.93). Conclusions: The results highlight the importance of the family's role in concurrent heroin use during MMT programs. The study's findings may have implications for family-based interventions that address concurrent heroin use.

Spatial distribution of HIV, HCV, and co-infections among drug users in the southwestern border areas of China (2004\u20132014): a cohort study of a national methadone maintenance treatment program

BackgroundA methadone maintenance treatment (MMT) program to curb the dual epidemics of HIV/AIDS and drug use has been administered by China since 2004. Little is known regarding the geographic heterogeneity of HIV and hepatitis C virus (HCV) infections among MMT clients in the resource-constrained context of Chinese provinces, such as Guangxi. This study aimed to characterize the geographic distribution patterns and co-clustered epidemic factors of HIV, HCV and co-infections at the county level among drug users receiving MMT in Guangxi Zhuang Autonomous Region, located in the southwestern border area of China.MethodsBaseline data on drug users’ demographic, behavioral and biological characteristics in the MMT clinics of Guangxi Zhuang Autonomous Region during the period of March 2004 to December 2014 were obtained from national HIV databases. Residential addresses were entered into a geographical information system (GIS) program and analyzed for spatial clustering of HIV, HCV and co-infections among MMT clients at the county level using geographic autocorrelation analysis and geographic scan statistics.ResultsA total of 31,015 MMT clients were analyzed, and the prevalence of HIV, HCV and co-infections were 13.05%, 72.51% and 11.96% respectively. Both the geographic autocorrelation analysis and geographic scan statistics showed that HIV, HCV and co-infections in Guangxi Zhuang Autonomous Region exhibited significant geographic clustering at the county level, and the Moran’s I values were 0.33, 0.41 and 0.30, respectively (P < 0.05). The most significant high-risk overlapping clusters for these infections were restricted to within a 10.95 km2 radius of each of the 13 locations where P county was the cluster center. These infections also co-clustered with certain characteristics, such as being unmarried, having a primary level of education or below, having used drugs for more than 10 years, and receptive sharing of syringes with others. The high-risk clusters for these characteristics were more likely to reside in the areas surrounding P county.ConclusionsHIV, HCV and co-infections among MMT clients in Guangxi Zhuang Autonomous Region all presented substantial geographic heterogeneity at the county level with a number of overlapping significant clusters. The areas surrounding P county were effective in enrolling high-risk clients in their MMT programs which, in turn, might enable people who inject drugs to inject less, share fewer syringes, and receive referrals for HIV or HCV treatment in a timely manner.

Prevalence of depressive symptoms among the clients maintained in methadone maintenance treatment programme at Tribhuvan University Teaching Hospital

Introduction: Depression is widely prevalent among the former opioid addicts in Methadone Maintenance Treatment (MMT). It is important to be aware of its severity as it plays a crucial role in methadone dosage, length of time in treatment and the relapse rate. The co-existence of depression is seen to worsen the prognosis in outcome of MMT.Objective: This study aimed to study the prevalence of the symptoms of depression among MMT clients.Method: This is a descriptive and Cross-Sectional study done in 60 MMT clients attending the out patients clinic in Tribhuwan University Teaching Hospital, Nepal. A structured proforma was constructed obtaining the data regarding age, sex, religion, occupation, marital status, literacy rate and socio-economical status. Depressive symptoms were evaluated using 21-item BDI scale.Result: Depressive symptoms were found in 63.3 % of the patients. 38.3% had mild to moderate depression, 15% had moderate to severe, and 11.7% had severe level of depressive symptoms. The depressive symptoms were most prevalent among females (90%) and age group 40-50 years. The prevalence of depressive symptoms were more in unmarried (82%), unemployed (65%), lower socio-economic class(71%) and completing only secondary level in education (73%).Conclusion: The major risk factors for depression among former opioid users were female gender, unmarried, low education level, unemployment and low socio-economic status.

Research with Older Adult Methadone Clients: The Importance of Monitoring Suicide Ideation

ABSTRACTThis study reports on the importance of monitoring suicide ideation among older adult research participants. A recently completed randomized controlled trial of older adults who are current clients in methadone maintenance treatment (MMT) served as a case study to elucidate a suicide protocol that was designed to account for the potential instances of suicide ideation within the research project structure. As the numbers of older adult heroin users increases, this study’s findings seek to influence research protocols that involve older adults with addictions who may be particularly vulnerable to suicide risk due to comorbid psychiatric conditions and psychosocial adversities.