Methadone Maintenance Clinic Research Articles

Defaulting rate and associated factors among patients attending methadone maintenance clinics in Nairobi City County, Kenya

Background: Defaulting from MMT clinics is a major public health problem affecting people globally resulting in high transmission of HIV, hepatitis B and C, increased crime rate, and reduced productivity of an individual. However, defaulting rate in the MMT clinics in Nairobi City County in Kenya remains understudied. This study was aimed at determining the defaulting rate and its associated factors from MMT clinics in Nairobi City County, Kenya. Methods: A cross-sectional analytical study design was employed. Simple random sampling, purposive sampling and stratified sampling were utilized in this study. A sample size of 388 patients was randomly selected. A semi-structured questionnaire was used for data collection. SPSS V.24 was used for data analysis. Results: A response rate of 95% (369) was achieved. Most were youths aged 18-35yrs (60.7%, n=224), male (76.4%, n=282), married (39%, n=144), Christians (51.8%, n=191). The defaulting rate was 53% with marital status, religion, education level, and income source being significantly associated with defaulting (p<0.05). Conclusions: The defaulting rate from MMT was relatively high in Nairobi City County. Defaulting was linked to education, cocaine use before MMT and concurrent drug use during treatment. A number of interventional strategies were proposed by this study to improve MMT programming.

Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study.

Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient's recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual's patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual's changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. KIOS tracks key clinical variables and generates advice specifically relevant to the patient's current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.

A Comparison of Willingness to Pay for Substance Use Disorder Treatment in Methadone Maintenance Clinics and Residential Facilities: The Role of Cost Payers' Income and Patients' Addiction Severity

A Comparison of Willingness to Pay for Substance Use Disorder Treatment in Methadone Maintenance Clinics and Residential Facilities: The Role of Cost Payers' Income and Patients' Addiction Severity

Impact of combination of intermittent theta burst stimulation and methadone maintenance treatment in individuals with opioid use disorder: A comparative study

Prior studies indicate that subjects undergoing methadone maintenance therapy (MMT) may experience anxiety, depression and cravings. This study aimed to explore the impact of intermittent theta burst stimulation (iTBS)-MMT combination on craving and emotional symptoms of opioid use disorder. This comparative study included subjects with opioid use disorder at the Methadone Maintenance Clinic of Pudong New Area between September 2019 and March 2020. The subjects were divided into two groups: those who received iTBS-MMT combination treatment (iTBS-MMT) and those who received MMT treatment and sham stimulation treatment (MMT). Outcomes were reduction rate of anxiety, depression and craving. Anxiety was measured by Hamilton Anxiety (HAMA) scale, depression was determined by Hamilton Depression (HAMD) scale and craving was analyzed using visual analog scale. A total of 76 subjects completed the treatment, with 38 subjects in each group. Twenty days after treatment, subjects in the iTBS-MMT group had significant improvement of anxiety (HAMA reduction rate), depression (HAMD reduction rate) and craving (Craving reduction rate) reduction rate compared with MMT group. iTBS-MMT combination treatment may produce better drug craving reduction and emotional improvement than MMT alone.

Psychometric Characteristics of the Persian Version of the Opiate Dosage Adequacy Scale (ODAS).

The opiate dosage adequacy scale (ODAS) is one of the most common assessment tools in studies on substance use disorders, which evaluates the "adequacy" of opiate medication doses in individuals recruited in maintenance approaches. There is no investigation on the Persian version of this questionnaire in Iran. This research validated a Persian version of the ODAS. The Persian version of the ODAS was translated and revised based on the original scale presented by González-Saiz et al. The psychometric characteristics of the ODAS were assessed via direct interviews. Three trained interviewers questioned 250 patients treated in methadone maintenance clinics in Mazandaran Province (Northern Iran) for more than three months. Internal consistency and factor analysis were conducted using SPSS software, version 24. The internal consistency of ODAS was satisfactory (Cronbach's α=0.81). Across all items, considerable inter-rater reliability was discovered (kappa values between 0.90 and 1). A four-component structure was produced by the factor analysis that accounted for 77.5% of the total variance. Cronbach's α coefficients of the four components of Heroin craving and overmedication, Consumption, objective opiate withdrawal symptoms, and subjective opiate withdrawal symptoms were 0.84, 0.91, 0.83, and 0.74, respectively. The reliability and validity of the Persian version of the ODAS were satisfactory in a sample of methadone maintenance subjects. The opiate dosage adequacy scale (ODAS) is a clinical tool for measuring the adequacy of methadone dosesThe Persian version of ODAS has good validity, internal consistency, and inter-rater reliability;The Persian version of the ODAS, as a valid and reliable tool, can be used for the Iranian people under methadone maintenance. In Iran, opioids are among the most common forms of illicit drugs. In opioid maintenance programs, the adequacy of methadone doses has an important effect on treatment outcomes. Clinicians typically assess the adequacy of doses based on the patient's response to the medication. Different tools are used in clinical studies to evaluate it. One of these tools is the ODAS, developed by González-Saiz et al. In the present study, we validated the Persian version of the ODAS for Iranian patients receiving methadone maintenance programs. The results confirmed the four-factor structure of the Persian ODAS and showed its good internal consistency and inter-rater reliability.

The Bilateral Effects of Sleep-Related Breathing Disorders and Opioid Agonist Use: A Vicious Cycle in Methadone Maintenance Clinics

The artical abstract is not available.

Trend differences over 20 years between two methadone maintenance clinics, one with and one without cannabis legalization

Background Although methadone maintenance treatment (MMT) guidelines are well established, patients' characteristics and outcome change over time may be affected by the legality of cannabis. Objective To study trend changes between two clinics over 20 years from Las Vegas (LV) and 27 years from Tel Aviv (TA). Methods Patients’ characteristics at admission, including drugs in urine at first and 13th month were obtained from their medical charts. Changes by year of admission and cumulative retention were analyzed. Results The LV MMT clinic (1724 patients) had a lower one-year retention rate compared to the TA MMT clinic (1014 patients) (46.4% vs. 74.4%, respectively, p < 0.0005), and a higher rate of opioid stop after one year (75.9% vs. 68.8%, respectively, p = 0.003). The age at MMT admission and the retention rates decreased in LV and increased in TA. The prevalence of cannabis and benzodiazepine misuse on MMT admission increased in LV with no change recorded in TA. Cocaine on MMT admission decreased in LV and increased in TA, while amphetamine use increased in LV and decreased in TA. Cox models multivariate analyses found cannabis on admission to predict shorter retention in LV (as younger age male and amphetamines), and cannabis after one year in TA (as did cocaine and opiates after one year and BDZ on admission). Conclusion Although cannabis prevalence increased only in LV where it was legalized, it was associated with poor outcomes in both clinics. Younger age, a known poor outcome predictor, may be related to decreased retention in LV.

Treatment adherence amongst drug users attending public and private methadone maintenance clinics in a northern province of Vietnam

BackgroundMethadone maintenance treatment (MMT) has been proven to be effective in improving health status and the quality of life of illicit drug users. Due to the quick expand of methadone program, socialization through co-payment service is a critical to the success of it. In Nam Dinh, Vietnam, MMT has been used in public clinics and one private clinic. Such effectiveness of this treatment has been found to depend largely on adherence to treatment. This study aims to explore the compliance rate and its influencing factors among drug users between public and private clinics in Nam Dinh province, Vietnam.MethodsA cross-sectional study was conducted on 395 participants from January to September in 2018 in three MMT clinics in Nam Dinh, Vietnam. We applied the convenience sampling technique to recruit respondents. Data on socioeconomics characteristics, MMT adherence (measured by Visual Analogue Scale – VAS) and level of social/family support were collected.Results43.3% of participants reported complete adherence to the MMT program during the time of research. Significant factors affect MMT adherence among illicit drug users including family income, history of drug rejections, concurrence in drug usage, far distance from MMT clinics, and having only peer. Patients in MMT private clinic had higher complete adherence than that of public MMT (OR = 1.82, 95% CI = 1.13; 2.94). Having contacts with peer drug users associated with a higher rate of incomplete adherence (OR = 2.83, 95% CI = 1.39; 5.73).ConclusionsThe findings support the establishment of private MMT clinics alongside public ones, while further researches to determine the optimal dose and ways to reduce the impact of peer drug user’s influence are encouraged to be conducted.

Factors Influencing Client Retention in Methadone Maintenance Treatment Clinics in the Kathmandu Valley

Introduction: Methadone maintenance treatment program is one of the accepted form of treatment modalities for opioid dependence individuals in Nepal. Retention in the treatment represents the assessment of the effectiveness of the treatment program. The aim of this study was to find out the factors associated with the retention of clients in the Methadone maintenance clinics in the Kathmandu Valley.&#x0D; Material and Method: A total of 84 clients were recruited from the 5 different methadone clinics of Kathmandu valley. A prospective follow-up design was used. The patients were followed up at the end of 6 months and retention rate was calculated. The patient was considered ‘drop out “if the patient did not take methadone for 7 consecutive days. Group differences between ‘dropout’ and non-dropout (retained) clients on MMT program were tested using t-test and Chi-square test for continuous variables and categorical variables respectively.&#x0D; Results: At the end of 6 months 63 patients still remained in the MMT program, so the retention rate was found to be 75% in the study. The factors associated with the retention included higher dosage of methadone (p&lt;0.001), history of multiple substance intake (p=0.004) and previous treatment history of the drug related problems (p=0.015).&#x0D; Conclusion: Opioid dependent individuals may stick to the MMT program for longer durtion if they are offered with higher dosage of Methadone and special attention should be given to the patients with history of poly substance abuse and prior treatment history to prevent their relapse.

Public policy, attitudes and willingness to pay for treatment of substance dependence in Iran

BackgroundEvaluation of costs and benefits of substance use treatment programs through a standard economic framework is necessary for optimal policy making. However, drug policy making is seldom supported by economic justification. Measurement of willingness to pay is a tool to provide better understanding of intangible substance use treatment outcomes and to help a balanced policy in treatment of substance use between maintenance treatment and abstinence-based approach. AimTo assess the reciprocal association between economic indexes and attitudes about substance use and its treatment as indicators of tendency toward the two different treatment. MethodWillingness to pay for treatment was measured by contingency valuation method among 109 treatment cost payers of which 78 subjects were from outpatient methadone maintenance clinics and 31 were from abstinence-based residential facilities. To analyze predictors of willingness to pay, we used income to capture heterogeneity of purchasing power among subjects. Further, we checked bivariate correlation of different attitudes of cost payers with willingness to pay. In the next step using backward regression equation we tried to reach the best specification of the model. Selected variables include cost payers’ attitudes toward substance use and its treatment, effectiveness of treatment, social attitude toward the condition of substance use in Iran, fairness of treatment prices, and government financial support for addiction treatment. ResultsIn methadone maintenance clinics the payers’ income had a pivotal role in determining willingness to pay for substance use treatment by 50% (p<0.001 ). On the other hand, in abstinence-based residential facilities positive attitude toward substance use (61%, p<0.01) was the major direct determinant of willingness to pay for treatment. Attitude to public financial support for substance use treatment (55%, p<0.01 ) and consumption experience (45%, p<0.01 ) showed an inverse association with WTP in regression equation. ConclusionThis study expanded the understanding of the nature of payment in different substance use treatment modalities. The suggestion to policy makers is that before taking position on different types of treatment services, it is necessary to pay attention to factors that determine values cost payers put on treatment. In other words, economic indexes, payers’ views about substance use and its treatment, and their opinion about effectiveness of substance use treatment programs may jeopardize the success of the policy.

Ethnic differences in psychosocial factors in methadone maintenance: Hmong versus non-Hmong

ABSTRACTLittle is known about the characteristics of U.S.-based Asian populations undergoing methadone maintenance treatment for opioid use disorders. We evaluated psychosocial factors in 76 Hmong and 130 non-Hmong on methadone maintenance for at least two months in a single urban methadone maintenance clinic. Assessments included the Addiction Severity Index 5th Edition, the Symptom Checklist-90, and the Structured Clinical Interview for DSM-IV Axis I Disorders. The Hmong were older, predominately male, and on lower doses of methadone than the non-Hmong. Hmong had significantly lower ASI composite scores across all dimensions except employment and legal. While the SCL-90 Global Severity Index (GSI) score did not differ between groups, the Hmong had lower scores in the interpersonal sensitivity, depression, anxiety, hostility, and paranoid ideation dimensions. Sixty-seven percent of Hmong and 29% of non-Hmong were without Axis I diagnoses (p < .001). There was no difference between the groups in DSM-IV substance use diagnoses. The extent to which these psychosocial differences impact methadone dose requirements and treatment outcomes in Hmong and non-Hmong remains unknown.

Comparisons of Alcohol and Drug Dependence in Terms of Attachments and Clinical Issues

ABSTRACTBackground: Alcohol and drug dependencies are associated with different social stigmas, and some studies suggest they might exhibit different clinical presentations. Further, the treatments for each vary considerably. Alcohol versus drug use problems were compared in terms of attachment patterns and related clinical treatment issues in two interlocking studies using converging logic and designs. Methods: In Study 1, alcohol versus drug dependence was defined in terms of a known groups design. Patients from an inpatient alcohol treatment center, patients receiving treatment for opiate dependence in a methadone maintenance clinic, and controls were compared on the 29 scales of the Attachment and Clinical Issues Questionnaire (ACIQ). Study 2 sampled a substantially different population (491 university students) and used different operational definitions of substance use problems, relying on screening instruments. Results: Study 1 found that, although the drug and alcohol dependent patients differed substantially from the controls, they did not differ from one another on any of the 29 ACIQ scales measuring attachments and clinical issues. Study 2 converged on the known groups design of Study 1, showing convergent and concurrent rather than discriminate evidence for the alcohol and drug dependence screening instruments. Conclusion: Alcohol and drug dependencies were not found to differ significantly in terms of attachments or clinical issues. These studies aimed to provide clearer and more empirically grounded guidance to the clinician and researcher.

Can a rapid measure of self-exposure to drugs of abuse provide dimensional information on depression comorbidity?

Addictions to heroin or to cocaine are associated with substantial psychiatric comorbidity, including depression. Poly-drug self-exposure (eg, to heroin, cocaine, cannabis, or alcohol) is also common, and may further affect depression comorbidity. This case-control study examined the relationship of exposure to the above drugs and depression comorbidity. Participants were recruited from methadone maintenance clinics, and from the community. Adult male and female participants (n = 1,201) were ascertained consecutively by experienced licensed clinicians. The instruments used were the SCID-I, and Kreek-McHugh-Schluger-Kellogg (KMSK) scales, which provide a rapid dimensional measure of maximal lifetime self-exposure to each of the above drugs. This measure ranges from no exposure to high unit dose, high frequency, and long duration of exposure. A multiple logistic regression with stepwise variable selection revealed that increasing exposure to heroin or to cocaine was associated greater odds of depression, with all cases and controls combined. In cases with an opioid dependence diagnosis, increasing cocaine exposure was associated with a further increase in odds of depression. However, in cases with a cocaine dependence diagnosis, increasing exposure to either cannabis or alcohol, as well as heroin, was associated with a further increase in odds of depression. This dimensional analysis of exposure to specific drugs provides insights on depression comorbidity with addictive diseases, and the impact of poly-drug exposure. A rapid analysis of exposure to drugs of abuse reveals how specific patterns of drug and poly-drug exposure are associated with increasing odds of depression. This approach detected quantitatively how different patterns of poly-drug exposure can result in increased odds of depression comorbidity, in cases diagnosed with opioid versus cocaine dependence. (Am J Addict 2017;26:632-639).

Initiation and Engagement with Methadone Treatment among Pregnant and Postpartum Women

PurposeThe purpose of this study was to explore perceptions of experiences and challenges with methadone maintenance treatment (MMT) and obstetrical care among pregnant and postpartum women enrolled in a methadone maintenance program. Research DesignThe study featured a grounded theory approach including two focus groups with pregnant and postpartum methadone users at a methadone maintenance clinic in Worcester, Massachusetts. Two research team members conducted and recorded focus groups, which took approximately 45 minutes to 1 hour. Grounded theory was used to guide data analysis and open coding, where transcripts were reviewed line by line to create code definitions as concepts emerged inductively from the data. ResultsFive emergent themes were derived from the data: 1) guilt, coupled with fear of negative outcomes for their infant, dictates women's MMT treatment decisions; 2) finding obstetricians with experience treating pregnant women using methadone can be a challenge; 3) methadone clinic physicians are instrumental in helping women find the right methadone dose during pregnancy; 4) some women had strong preferences for methadone over buprenorphine; and 5) women face substantial substance abuse treatment challenges after delivery. ConclusionsWomen experience substantial challenges engaging in MMT during the perinatal period. Additional challenges arise from finding obstetrical providers who have experience with MMT and are willing to care for pregnant women. This study may provide a starting point for future interventions seeking to improve care coordination between substance abuse treatment and prenatal care programs.

Report on Provider–Client Interaction From 68 Methadone Maintenance Clinics in China

ABSTRACTProvider–client interaction is an integral of clinical practice and central to the delivery of high-quality medical care. This article examines factors related to the provider–client interaction in the context of methadone maintenance treatment (MMT). Data were collected from 68 MMT clinics in China. In total, 418 service providers participated in the survey. Linear mixed effects regression models were performed to identify factors associated with provider–client interaction. It was observed that negative attitude toward drug users was associated with lower level of provider–client interaction and less time spent with each client. Other factors associated with lower level of interaction included being female, being younger, being a nurse, and fewer years in medical field. Higher provider–client interaction was associated with provider reported job satisfaction. The findings of this study call for a need to address provider negative attitudes that can impact provider–client interaction and the effectiveness of MMT. Future intervention efforts targeting MMT providers should be tailored by gender, provider type, and medical experiences.

Sexual Abuse and its Relation to Chronic Pain among Women from a Methadone Maintenance Clinic versus a Sexual Abuse Treatment Center

ABSTRACTTo determine the effect of sexual abuse history on chronic pain and its relation to opioid addiction and methadone maintenance treatment (MMT), we studied current women MMT patients, and women patients from a sexual abuse treatment center with no history of opioid addiction. Questionnaires included Chronic Pain, Chronic Severe Pain, the Yale-Brown Obsessive Compulsive Scale, the Dissociative Experiences Scale (DES), and the Structured Interview for Disorders of Extreme Stress (complex-PTSD). Chronic severe pain was most prevalent among sexually abused women with no history of opioid addiction (64% of 25), followed by sexually abused MMT women (30.9% of 68), and MMT women with no history of sexual abuse (25% of 8, p = 0.01). Pain severity correlated with dissociation and complex-PTSD scores. The sexually abused non-MMT women had higher rates of high dissociation scores (DES ≥ 30) and complex-PTSD, but fewer obsessive-compulsive disorder symptoms (scored ≥16) than the MMT sexually abused women. Chronic pain was found to be highly prevalent among sexually abused women, independent of being methadone-maintained with an addiction history. The high known prevalence of chronic pain among MMT patients, which may be attributable to opioid-induced hyperalgesia, may partially reflect the sexual abuse history, and should be targeted in future studies evaluating pain indices.

Doświadczanie w dzieciństwie przemocy fizycznej wśród pacjentów uzależnionych od opioidów leczonych substytucyjnie – doniesienie wstępne

IntroductionThere is growing evidence that childhood physical abuse leads to worse health and social functioning. Among others, physical maltreatment increases risk of developing substance dependence. The aim of the present study was to analyse the association between childhood physical abuse and social and medical conditions in opioid-dependent patients recruited in the methadone maintenance clinic. To the best of our knowledge, there have been no such studies in the Polish population. MethodA sample of 240 opioid-dependent individuals were interviewed using standardised measures, which covered childhood maltreatment, family history, health conditions and social problems. Persons physically abused before 18 years of age were compared with those who had not such experiences. ResultsThe prevalence of physical abuse in childhood was higher among women (34.3%) than men (19.4%). Physical abuse was associated with more severe symptoms of addiction, suicide attempts, more severe depressive symptoms, worse social functioning and family dysfunction. In addition, physical abuse victims reported greater pain intensity. DiscussionThe results of the present study confirm that exposure to childhood maltreatment is related to socio-economic status and psychopathology in opioid-dependent patients. More research is needed to investigate the relationships between physical abuse in childhood and perception of pain in opioid-dependent individuals. ConclusionThe detailed assessment of childhood and adolescence maltreatment in opioid-dependent patients may facilitate and accelerate identification of co-existing dysfunctions and risks.

Molestowanie seksualne przed uzyskaniem pełnoletności a stan zdrowia i funkcjonowanie społeczne osób uzależnionych od opioidów leczonych substytucyjnie

IntroductionA number of previous studies confirmed worse health and social conditions among opioid-dependent individuals with a childhood history of sexual abuse. To the best of our knowledge, this issue has not been investigated in the Polish population. We aimed to analyse the prevalence of sexual abuse in opioid-dependent individuals undergoing therapy in the methadone maintenance clinic and to assess the association of clinical and social characteristics with a history of sexual abuse. MethodThe study included a sample of 240 opioid-dependent patients. Participants were interviewed using self-reported questionnaire and standardised measures on experience of childhood and adulthood abuse, physical and mental health, addictions, social functioning and family history. ResultsAbout 35% of women reported sexual violence in childhood. Sexual abuse in this period was associated with family dysfunction, physical abuse, current more intensive depressive symptoms and pain, as well as suicide attempts with stronger morbid desires. DiscussionThe present findings are consistent with previous research of other authors. Interestingly, the present study did not confirm the relationship between sexual abuse and severity of opioid or alcohol dependence and poor social functioning. ConclusionThe results of our study suggest the potential benefit to multifaceted treatment approach, which should specifically address sexual abuse and suicidal behaviour in opioid-dependent patients.

Somatic Comorbidity and Other Factors Related to Suicide Attempt Among Polish Methadone Maintenance Patients.

Fatal and nonfatal suicide attempts are far more common in opioid-dependent individuals than in the general population. More research is needed to understand the specific risk factors for suicidal behaviors in this patient population, particularly outside of the United States and Western Europe. This study investigated the correlates of suicide attempts among Polish patients in methadone maintenance treatment and interpreted results in the context of findings from other countries. The study was based on a sample of 240 individuals recruited from a methadone maintenance clinic in Poland. Participants were interviewed using standardized measures. Consistent with studies in other countries, sexual abuse, depression, alcohol dependence, and impulsivity were associated with suicide attempt. Additionally, those patients with somatic comorbidity had an increase in odds (odds ratio = 2.6) of suicide attempt. The results of our study suggest a potential benefit to treatment approaches that address somatic concerns of methadone-maintenance patients. More research is needed to identify, assess, and understand possible cultural and regional differences between opioid-dependent populations to better tailor prevention strategies.

“Hepatitis C treatment turned me around:” Psychological and behavioral transformation related to hepatitis C treatment

BackgroundHepatitis C (HCV) is a significant public health problem that primarily affects current and former substance users. However, individuals with a history of substance use are less likely to have access to or engage in HCV care. Psychological and behavioral barriers prevent many HCV-infected individuals from initiating or engaging in HCV treatment. This study aimed to investigate the psychological and behavioral experiences of current and former substance users receiving HCV treatment within a combined methadone and primary care clinic in the United States. MethodsWe conducted 31 semi-structured qualitative interviews with opioid-dependent adults enrolled in an integrated HCV treatment program within a methadone maintenance clinic in the Bronx, NY. We used thematic analysis, informed by grounded theory, and inquired about perceptions of HCV before and after initiating HCV treatment, reasons for initiating HCV treatment, and the decision to participate in individual versus group HCV treatment. ResultsParticipants described psychological and behavioral transformation over the course of HCV treatment. These included reductions in internalized stigma and shame related to HCV and addiction, increases in HCV disclosure and self-care, reductions in substance use, and new desire to help others who are living with HCV. ConclusionsIntegrating HCV treatment with methadone maintenance has the potential to create psychological and behavioral transformations among substance using adults, including reductions in HCV- and addiction-related shame and improvements in overall self-care.