Methadone Maintenance Therapy Program Research Articles

Chronic exposure to methadone induces activated microglia and astrocyte and cell death in the cerebellum of adult male rats.

Methadone is a centrally-acting synthetic opioid analgesic widely used in the methadone maintenance therapy (MMT) programs throughout the world. Considering its neurotoxic effects particularly on the cerebellum, this study aims to address the behavioral and histological alterations in the cerebellar cortex associated with methadone administration. Twenty-four adult male albino rats were randomized into two groups of control and methadone treatment. Methadone was subcutaneously administered (2.5-10mg/kg) once a day for two consecutive weeks. The functional and structural changes in the cerebellum were compared to the control group. Our data revealed that treating rats with methadone not only induced cerebellar atrophy, but also prompted the actuation of microgliosis, astrogliosis, and apoptotic biomarkers. We further demonstrated that treating rats with methadone increased complexity of astrocyte processes and decreased complexity of microglia processes. Our result showed that methadone impaired motor coordination and locomotor performance and neuromuscular activity. Additionally, relative gene expression of TNF-α, caspase-3 and RIPK3 increased significantly due to methadone. Our findings suggest that methadone administration has a neurodegenerative effect on the cerebellar cortex via dysregulation of microgliosis, astrogliosis, apoptosis, and neuro-inflammation.

Prevalence of Domestic Violence Against Women Undergoing Methadone Maintenance Therapy Programs and its Related Risk Factors.

This study aimed to investigate the prevalence of domestic violence (DV) against women who are undergoing methadone maintenance therapy (MMT) and its related risk factors. This case-control study was conducted on 195 women who were under MMT and a control group consisting of 195 women who were not under it in the city of Zahedan from 22 May to 1 December 2019. Data were collected using a questionnaire for the measurement of violence against women and a sociodemographic questionnaire. In order to analyze the data, the t test, analysis of variance (ANOVA), Pearson's correlation, and multiple regression analysis were used. In the case group, 67.2% of participants had experienced DV during the past year. In the control group, the prevalence was 78.5%. The rate of more than one occasion of DV was significantly higher in the group who were under MMT (P<0.05). The most common type of violence was mental abuse. Physical, sexual, and economic abuses were in the next ranks. Important predictors of DV, in order of importance, were: the women's low educational level, smoking, income level, and polygamy (P<0.05). MMT is not a risk factor for DV. It seems that the rate of DV against women in Zahedan is very high. The prevalence of recurrent DV in women under MMT was higher than in the general population.

Chronic exposure to methadone impairs memory, induces microgliosis, astrogliosis and neuroinflammation in the hippocampus of adult male rats

Methadone is a centrally-acting synthetic opioid analgesic widely used in methadone maintenance therapy (MMT) programs throughout the world. Given its neurotoxic effects, particularly on the hippocampus, this study aims to address the behavioral and histological alterations in the hippocampus associated with methadone administration. To do so, twenty-four adult male albino rats were randomized into two groups, methadone treatment and control. Methadone was administered subcutaneously (2.5–10 mg/kg) once a day for two consecutive weeks. A comparison was drawn with behavioral and structural changes recorded in the control group. The results showed that methadone administration interrupted spatial learning and memory function. Accordingly, treating rats with methadone not only induced cell death but also prompted the actuation of microgliosis, astrogliosis, and apoptotic biomarkers. Furthermore, the results demonstrated that treating rats with methadone decreased the complexity of astrocyte processes and the complexity of microglia processes. These findings suggest that methadone altered the special distribution of neurons. Also, a substantial increase was observed in the expression of TNF-α due to methadone. According to the findings, methadone administration exerts a neurodegenerative effect on the hippocampus via dysregulation of microgliosis, astrogliosis, apoptosis, and neuro-inflammation.

Erectile Dysfunction in Patients with Substance Abuse: A Preliminary Report in Bandung, West Java, Indonesia

Substance abuse (psychoactive) has multiple adverse effects, i.e., biological, psychological, economic, social or legal. Among the biological effects, little is known about its impact on sexual function, especially erectile dysfunction (ED) in men. The study’s objective was to determine the patient’s risk factors of ED comorbid with substance abuse at the Methadone Maintenance Therapy Program Clinic (MMTPC), Hospital Dr. Hasan Sadikin Clinic, Bandung, Indonesia. This was a crosssectional study among patients at the MMTPC, Hospital Dr. Hasan Sadikin Clinic, Bandung, Indonesia. We obtained the ED data using the self-reporting International Index of Erectile Function (IIEF-5) questionnaire. Based on 30 respondents who attended the clinic, the age of the subjects ranged from 24-52 years, with a mean age of 40 years. The respondents with substance abused included those misusing opioids (N= 27, 90%), cannabis (N = 18, 60%), amphetamines (methamphetamines and ecstasy) (N= 10, 33.3%), benzodiazepine drugs (N= 7, 23.3%), alcohol (N= 2, 6.7%) and others (antidepressants and suboxone) (N= 2, 6.7%). ED occured in 90% of the respondents (n=27) where 64% (n=19) had mild, 23% (n=7) mild-moderate, 3% (N=1) moderate ED, and 10% (n=3) without an ED. There was no severe ED in the subjects of this study. Respondents without multiple drug abuse had a lower degree of ED with a median IIEF-5 score of 17.0 (IQR: 15.0-20.0) compared to those taking multiple substances (Median score = 20.0, IQR: 18.5-21.0). Respondents who reported cannabis use had a lower median IIEF-5 score of 17.0 (IQR: 15.0- 20.3), i.e., lesser ED than those with multiple drug substances (Median score = 19.5, IQR: 19.0-21.0). We performed additional analyses to identify variables, i.e., age, total type of drugs used, and duration of use in years associated with lower IIEF-5 scores and none of thosee variables showed a significant correlation with the IIEF-5 score (Spearman’s correlation coefficients &gt;0.05). In conclusion, a high incidence of ED in substance abuse patients undergoing methadone maintenance therapy programmes requires special attention from healthcare workers during the consultation in MMTPC.

The Prevalence and Psychosocial Correlates of Ketum (Mitragyna speciosa) Use among Individuals on Methadone Maintenance Therapy Programme in Hospital Taiping, Malaysia.

Ketum use is significantly prevalent amongst individuals in the northern states of Peninsular Malaysia. This study aims to investigate the prevalence and psychosocial correlates of Ketum use in individuals who are in the Methadone Maintenance Therapy (MMT) Programme at the Hospital Taiping. This is a cross-sectional study conducted in the methadone clinic at the Hospital Taiping. The study instruments used were Subjective Opiate Withdrawal Scale (SOWS), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) questionnaire, and Kratom Dependence Scale (KDS). A total of 215 subjects were recruited for this study. The prevalence of ketum users was 49.3% (n = 106). Chinese and Indian ethnicity had a lower tendency to use ketum compared to Malay ethnicity, with OR = 0.386 (95% CI 0.134, 1.113) and 0.119 (95% CI 0.035, 0.408), respectively. Individuals who used other illicit drugs had a higher tendency to use ketum with the adjusted OR = 9.914 (95% CI: 1.109, 88.602). Every one unit increase in SOWS increased the odds of being a ketum user by 1.340 (95% CI: 1.070, 1.677), whereas every one unit increase in duration in the MMT programme reduced the odds of being a ketum user by 0.990 (95% CI: 0.982, 0.998). Ketum use is prevalent amongst those in the MMT programme in this study. The high prevalence of ketum use is of concern and further interventions should be carried out to address this.

Prevalence of Respiratory Disorders during Sleep among Subjects of Methadone Maintenance Therapy Program.

BackgroundRespiratory disorders during sleep are considered a health problem affecting the life quality. There is some evidence indicating the higher prevalence of apnea in substance-dependent patients. However, there is no information on the prevalence of the disease in people under methadone maintenance therapy (MMT). Therefore, the present study was designed to estimate the disease rate in these patients and consider the relationship of the increasing risk of apnea with some psychiatric problems.MethodsStudy group included 152 individuals under the MMT program. Baseline data were collected with the interview, and patients were considered using the STOP-BANG questionnaire to evaluate the risk of apnea. Furthermore, Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HDRS) tests were performed for all participants. Data were analyzed using SPSS software.FindingsBased on the STOP-BANG score categories, 37.5%, 40.1%, and 22.4% of patients indicated low, intermediate, and high risk of apnea, respectively. Moreover, severe daytime sleepiness, fatigue, depression, and anxiety were observed in 5.3%, 5.5%, 6.0%, and 21.1% of participants, respectively. Sex (P = 0.007) and daytime sleepiness (P = 0.048) were significantly different between low and high-risk groups of apnea after adjustment. Besides, age (P < 0.001) and fatigue (P = 0.007) were factors predicting the STOP-BANG score.ConclusionThese findings revealed the higher prevalence of apnea in MMT patients compared to the general population of Iran and rising of the risk of apnea along with an increase in age and fatigue score. However, attention to the sleep disorders in MMT is a prominent factor that should be considered as a route of therapy.

Examining common mental health disorders in people living with HIV on methadone maintenance therapy in Hanoi, Vietnam

BackgroundInjection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam.MethodsThis cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance.ResultsOf the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed.ConclusionThere is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.

Accidental Methadone Poisoning in a Four-Year-Old Child Reversed With Continuous Intravenous Infusion of Naloxone

Reported case of methadone poisoning among children is infrequent in Malaysia. Since the implementation of methadone maintenance therapy (MMT) programme by Malaysian Ministry of Health in year 2006, there are only three case reports of methadone poisoning in children. Methadone toxicity in children can be deadly if antidote and supportive measures are not instituted in time. We report a case of accidental ingestion of about 25 mg of methadone in a 4-year-old boy. The methadone syrup belonged to his father, a former intravenous drug user (IVDU), who is currently a participant of the MMT detoxification programme under the supervision of a licensed general practitioner. The child presented with typical early signs and symptoms opioid toxicity. Upon examination, vital signs were normal, but he appeared lethargic and drowsy. Venous blood gas results noted mild respiratory acidosis and complete blood count revealed leukocytosis. He was treated with continuous intravenous infusion (CIVI) naloxone 10 µg/kg/h for approximately 78 h. He was hospitalized for 6 days and discharged well. Advice should be given to family who has patient under MMT programme with take-home doses to be more cautious in storage of methadone syrup at home, and to keep the bottle far from the reach of children. Methadone poisoning in children can be deadly and early administration of naloxone as CIVI can effectively reverse its toxicity. Int J Clin Pediatr. 2021;10(1):18-23 doi: https://doi.org/10.14740/ijcp386

Risk of Depression Among MMT Patients: Does Coping Strategies and Perceived Social Support Play a Role?

Introduction:Patients receiving methadone maintenance therapy (MMT) experience higher level of stress and are at greater risk of developing mental health problems such as depression which could potentially affect both quality of life and treatment outcomes. This cross-sectional study is aimed at understanding the relationship between psychosocial factors such as social support, coping, and depression among patients receiving MMT in a Malaysian Hospital.Methods:One hundred and ninety-six patients attending MMT program were recruited. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depression, Multidimensional Scale of Perceived Social Support (MSPSS) was used to assess participants’ perceived social support, and the Brief COPE questionnaire was used to assess coping strategies. The diagnosis of depression was made using Mini-International Neuropsychiatric Interview (MINI).Results:About 13.8% of our sample were diagnosed with depression. From our analysis, it was found that having higher levels of perceived social support (OR = 0.462, 95% CI 0.238-0.899, P < .05), the use of active and emotion focused coping mechanism (OR = 0.231, 95% CI 0.095-0.565, P < .005), and support seeking and self-distraction coping mechanism (OR = 0.196, 95% CI 0.074-0.521, P < .001) was associated with lower likelihood of depression. On the contrary, the use of dysfunctional coping strategies such as denial, behavioral disengagement, and self-blame was associated with increased likelihood of depression (OR = 9.384, 95% CI 3.081-28.581, P < .001).Conclusion:Active and emotion focused along with support and self-distraction coping strategies, and higher levels of perceived social support may serve as a buffer against depression in patients receiving MMT.

Describing the Programme on Methadone Maintenance Therapy in Selangor, Malaysia

INTRODUCTION: Drug addiction and drug abuse is a serious public health problem worldwide. Millions of people worldwide suffered from drug use disorders, directly and indirectly, attributable to drug use and included deaths related to HIV and hepatitis C acquired through unsafe injecting practices. Many parts of the world have a shortfall in prevention and treatment for drug use disorders, with only less than 10% of people with drug use disorders receiving treatment yearly. Medication-assisted treatment of opioid dependence like Methadone is used in maintenance therapy or detoxification helps people with drug use disorders. &#x0D; &#x0D; MATERIAL AND METHODS: Secondary data from an existing electronic dataset in Ministry of Health (MOH) from 2015 until 2019, which includes registered patients who had undergone Methadone Maintenance Therapy (MMT) either government or private facilities were included. The dataset divided into few domains namely socio-demographic, treatment modalities, clinic location and history of infection.&#x0D; &#x0D; RESULTS: A total of 37 various government and private facilities deliver MMT programme in the state of Selangor offered to a total of 5337 patients. The youngest patients were in the early twenties and oldest were in late seventies. The median age of patients was 45 years and the majority were males. Most of them were having secondary education (SPM holder) and below. Most of MMT programme takers were opioid drug users then followed by Amphetamine Type Stimulant (ATS) as the second most used. Among MMT programme takers, about 34.1% were reactive for Hepatitis C, 6.6% reactive for HIV, 4.2% reactive for Hepatitis B and 1.7% acquired tuberculosis infection. Almost 5% of MMT takers had passed away, which the three main causes of death were AIDS, alleged motor vehicle accident and septic shock. None of MMT takers was died due to methadone. &#x0D; &#x0D; CONCLUSION: It is a great concern of the nation in combating drug-related problems due to the growing number of substance abusers. This review concluded that the MMT programme that widely available had shown a positive outcome by keeping lower mortality among MMT patients.

Thymoquinone: From Nigella sativa to a protective pharmacological compound in managing opioid dependence and amphetamine type stimulant issues.

Opioids, amphetamines, and other types of substances have been widely abused around the world. Opioid dependence and tolerance are two distinct phenomena that have been associated with substance abuse issues. The management of its adverse consequences is becoming more challenging. More and more people are treated in Methadone Maintenance Therapy (MMT) program yet the issues are still unresolved. Researchers are continuing to study the best formulation in treating opioid dependent people starting with modern and alternative drug therapies. Since 2008 , thymoquinone (TQ) has been extensively studied by researchers around the world and has emerged to be a new potential drug candidate in managing substance abuse issues. Thus, the aim of this article is to review the effects that TQ may have on opioid dependent subjects and other abused substances such as amphetamine may have been studied. All of the articles from 2008 until 2019 involving the effects of TQ on substance abuse from Google Scholar®, Scopus®, and Pubmed® databases have been searched and reviewed. The keywords used were thymoquinone, opioid dependence, amphetamine, and Nigella sativa. The research results also have been discussed in this article. Based on the research conducted, TQ was effective in reducing the adverse health consequences associated with substance abuse such as withdrawal symptoms, tolerance, and cell damages. It is concluded that TQ could be a potential drug that can be complemented with the currently available drugs in substance abuse therapies.

Exploring the Therapeutic Effects of Transcranial Direct Current Stimulation on Sleep Quality Among Patients Under Methadone Maintenance Treatment

Background: Patients under Methadone Maintenance Therapy (MMT) are susceptible to several problems, including sleep disturbances and risk of relapse. The present study aimed to assess the effect of transcranial direct current stimulation (tDCS) on sleep quality of addicts under MMT.Methods: This clinical trial was conducted on 27 male patients who underwent maintenance methadone therapy in MMT clinics of Mashhad City, Iran. They were divided into the experimental and sham groups. The experimental group received seven 20-min sessions of tDCS every other day. In the sham group, the electrical current was delivered for a few seconds, but the electrodes were remained to the end of the session. Sleep quality was measured at baseline, during, and after the intervention by Pittsburg Sleep Quality Index (PSQI). The obtained data were analyzed by descriptive statistics such as mean and standard deviation and inferential statistics, such as t test, Chi-square, Mann Whitney, and Fischer exact test in SPSS v. 25.Results: The difference between the two groups after tDCS in sleep duration was significant (P=0.04). In the experimental group, the total score of sleep had a reducing trend (P&lt;0.000), while in the sham group, the overall score in 3 phases of evaluation had no significant change (P=0.19). However, the rate of inappropriate sleep quality was not significant between the two groups after the intervention (P=0.12).Conclusion: This trial demonstrated the positive effect of tDCS on sleep quality in patients under MMT programs. Further studies are needed to confirm our findings.

Experiences of Clients in Three Types of Methadone Maintenance Therapy in an Atlantic Canadian City: A Qualitative Study.

Methadone maintenance therapy remains the most common form of substitution therapy for opioid use disorder in Canada. Effectiveness of methadone maintenance therapy has been established, but recently newer treatment delivery models have emerged. Differences across these treatment models have not been examined. This descriptive qualitative study used semi-structured interviews to assess client experiences in three methadone maintenance therapy treatment delivery models: (a) comprehensive programs, (b) low-threshold/high-tolerance programs, and (c) fee-for-service programs. A total of 32 participants were recruited from methadone maintenance therapy clinics in an Atlantic Canadian city and grouped into three models of care (na = 9, nb = 11, nc = 12). Content analysis was performed on interview data to assess the frequency of relevant themes in the data. Participants from all groups stressed the importance of supportive staff and having access to some form of counselling. However, low-threshold/high-tolerance and fee-for-service clients voiced a need for more formal counselling and programming at their clinics. Methadone was reported as the most helpful aspect of the methadone maintenance therapy programs; however, participants also expressed negative views about the substance. These findings have important implications for the development and implementation of methadone maintenance therapy, specifically pertaining to further integration of addiction and mental health services.

RELATIONSHIP OF SALIVA pH AND DMF-T INDEX IN METADON HOUSING THERAPY IN YOGYAKARTA CITY

One of the factors causes dental caries is salivary state. Drug addicts may have different salivary pH due to the drug content that is commonly consumed. The purpose of this study was to determine the relationship of salivary pH to the DMFT index in the Methadone Maintenance Therapy group in the city of Yogyakarta. This type of observational analytic study is Case control design. A sample of 64 subjects, divided into 2 case and control groups. Case groups are people who are members of the Methadone Maintenance Therapy Program at the Gedongtengen Health Center in Yogyakarta. Saliva pH measuring instrument is a pH strip. Test the relationship between salivary pH and DMFT using the Spearman rank test. The results showed that the average DMF-T in the case group was 8.4, higher than the control group 2.1 while the saliva pH of the PTRM group in the acid category (5.8) was lower than the control group with a neutral pH category (6.6). There is a significant relationship between salivary pH and DMF-T index in the Methadone Maintenance Therapy group in Yogyakarta City.

Implementation of the Methadone Maintenance Therapy Program for Highrisk Drug Prisoners

&lt;p&gt;The harm reduction program is a program that aims to assist inmates who use syringes (IDU's) in overcoming dependence on narcotics medically and to prevent the adverse effects caused by narcotics abuse. Where in general the use of heroin is done by injecting using a syringe alternately, or known as "For Wet" This can cause a new problem that is greater that the outbreak of the HIV/AIDS virus. Most prisoners use injecting narcotics before entering prison and have been infected with the HIV virus, so the risk of transmitting HIV/AIDS to other prisoners is very high. The tendency of the number of relapses (reuse) by prisoners who are in the period of coaching is quite high despite the efforts of strict supervision in the security sector, but in fact in several prisons/detention there is narcotics smuggling in various modes. For this reason, the Indonesian Ministry of Law and Human Rights through the Directorate General of Corrections organizes the P4GN program (Prevention of Eradication of Narcotics Abuse and Circulation) in prisons and detention environments by promoting the principle of "Total Abstinence" meaning that no use of any type of narcotics during coaching in prisons and prisons. But for the type of metadone, which is a type II narcotics can be tolerated because it is used for the purpose of treatment/healing of narcotics dependence and is also a government program implemented by the Ministry of Health as the leading sector.&lt;/p&gt;

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

BackgroundEmerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa.MethodsWe enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization’s Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar’s test was used for comparisons between paired results of categorical variables relating to injecting frequency.ResultsThe majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254).ConclusionsInterim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.

Time to Treatment Initiation and Retrospective Analysis of Antiretroviral Therapy Outcomes among HIV-positive Methadone Maintenance Therapy Clients in Primary Health-care Centers, Kuantan, Pahang.

ABSTRACTIntroduction:Methadone maintenance therapy (MMT) program helped to improve access to antiretroviral therapy (ART) among people who inject drugs (PWID) with human immunodeficiency virus (HIV). However, the time to treatment initiation (TTI) and outcomes of ART intervention in this population have scarcely been analyzed.Objectives:The aim of this study was to analyze the TTI and outcomes of ART among MMT clients in primary health-care centers in Kuantan, Pahang.Materials and Methods:This was a retrospective evaluation of MMT clients from 2006 to 2019. The TTI was calculated from the day of MMT enrolment to ART initiation. The trends of CD4 counts and viral loads were descriptively evaluated. Cox proportional hazard model was used to analyze the survival and treatment retention rate.Results:A total of 67 MMT clients from six primary health-care centers were HIV-positive, of which 37 clients were started on ART. The mean TTI of ART was 27 months. The clients who were given ART had a mean CD4 count of 119 cells/mm3 at baseline and increased to 219 cells/mm3 after 6 months of ART. Only two patients (5.4%) in the ART subgroup had an unsuppressed viral load. The initiation of ART had reduced the risk of death by 72.8% (hazard ratio = 0.27, P = 0.024), and they are 13.1 times more likely to remain in treatment (P < 0.01).Conclusion:The TTI of ART was delayed in this population. MMT clients who were given ART have better CD4 and viral load outcomes, helped reduced death risk and showed higher retention rates in MMT program.

Temporal associations between medication adherence for patients with schizophrenia and opioid dependence: A 17-year Canadian Cohort Study

The current study investigated whether a previously reported beneficial effect of methadone maintenance therapy (MMT) on antiretroviral adherence is also present in relation to antipsychotic treatment for schizophrenia. Administrative data were linked over a 17-year period for 1996 people who were dually diagnosed with schizophrenia and opioid dependence and, as an indicator of further marginalization, experienced at least one episode of correctional supervision in British Columbia. Adherence was estimated using the medication possession ratio (MPR ≥ 0.80), calculated in each 120-day period beginning with the first date of concurrent use of MMT and antipsychotic medication. Generalized Estimating Equations were used to estimate the association between independent and dependent variables. The probability of antipsychotic adherence doubled in periods that were preceded by a period of MMT adherence (AOR: P: 2.07; 95% CI: 1.90–2.26). Subgroup and sensitivity analyses yielded results similar to those derived through the primary analysis, examining: conviction history; length of follow-up; initiation of MMT prior to antipsychotic induction; excluding participants who died during the study period; and restricted to participants who received methadone exclusively as part of a MMT program. Despite a strong temporal association between MMT and antipsychotic adherence, overall MPRs for both prescriptions remained <0.50 throughout the study period. Antipsychotic adherence was more than twice as likely following periods of adherence to MMT among dually-diagnosed patients. Research is needed to identify the conditions responsible for MMT adherence, and to further clarify the relationship between opioid agonist treatment and antipsychotic pharmacotherapy in this vulnerable and under-studied population.

PG-12 Viral suppression among HIV-infected methadone-maintained patients: The role of ongoing injection drug use and adherence to antiretroviral therapy (ART)

Introduction: Methadone maintenance therapy (MMT) is associated with improved virologic outcomes among HIV-infected opioid-dependent individuals, which support the use of MMP as part of the integrated approach to improve HIV treatment and care continuum. However, opioid-dependent individuals stabilized on MMT are highly diverse and beyond the benefit of HIV treatment as prevention (TasP) efforts. Given the critical role of sustained viral suppression in maximizing benefits of antiretroviral therapy (ART), we sought to assess factors associated with viral suppression in patients stabilized on MMT. Identifying subgroups at-risk for not achieving viral suppression and addressing factors causing the disparities could inform approaches to optimize HIV treatment outcomes and prevention efforts (eg, HIV TasP). Methods: A sample of 133 HIV-infected, methadone-maintained patients who reported HIV-risk behaviors were enrolled from a community-based methadone maintenance drug treatment facility in New Haven, Connecticut. Participants were recruited through clinic-based advertisements and flyers, word-of-mouth, and direct referral from counselors in the methadone clinic. Participants were assessed using an audio-computer assisted self-interview (ACASI). Multivariable logistic regression was used to identify significant correlates of viral suppression. Additionally, we examined the interactive effect of pairs of variables in the main effects model to determine the moderated effect on viral suppression. Model fit was assessed using a Hosmer and Lemeshow Test. Results: The mean age of participants was 49.3 (±8.3) years. The mean duration of HIV diagnosis was 14.1 (±9.6) years and 63.2% of participants reported to have disclosed their HIV status to a sexual partner. Of 121 (91.0%) individuals who were taking ART, 57.9% had achieved optimal adherence, and 80.4% had achieved viral suppression. Self-reported HIV risk behaviors were highly prevalent among study samples. Almost half of participants (46.6%) reported injecting illicit drugs in the past 30 days. Of those, 58.1% reported having shared injection equipment. Similarly, 21.1% of participants reported having sex with more than one sexual partner, and only 14.3% reported always using condoms with their sexual partners in the past 30 days. Having optimal adherence to ART was associated with an over four-fold odds (aOR = 4.883, P = 0.009) and having high CD4 count was associated with a two-fold odds of being virally suppressed (aOR = 2.483, P = 0.045). Additionally, participants who reported having injected drugs in the past 30 days (aOR = 0.081, P = 0.036) were significantly less likely to achieve viral suppression. Furthermore, we found a significant interaction effect that involved optimal ART adherence and injection of drugs on viral suppression (aOR = 2.953, P = 0.029). That is, the influence of optimal ART adherence on viral suppression was reduced due to ongoing injection drug use practices. Conclusions: Overall, our findings illustrated how the benefit of MMT programs may be negated among a significant segment of methadone-maintained patients and highlights unaddressed HIV-related treatment challenges faced by this risk group. These findings have important implications for the recently identified concept of HIV TasP as a clinical care strategy to reduce the harmful impact of ongoing HIV replication among HIV-infected individuals as well as transmission risk between serodiscordant couples. As advocates have recently called for the recognition of “undetectable = untransmittable” (U=U) campaign, clinical care of HIV-infected individuals, including those for methadone-maintained patients, could be enhanced by improving communication and counseling about the importance of consistent ART adherence and viral suppression. As such, future interventions should encourage both HIV-infected individuals and their partners to discuss options for HIV and other sexually transmitted infections (STIs) prevention, including HIV and STI treatment, condoms, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) within substance abuse treatment settings.

An intervention to improve provider-patient interaction at methadone maintenance treatment in China

BackgroundThis study evaluated an intervention aiming to improve methadone maintenance therapy (MMT) service providers' interaction with their patients in China. MethodsSixty-eight MMT clinics were randomized to either an intervention or a control condition. Providers in the intervention group attended three group training sessions to enhance their communication skills. Trained providers were encouraged to practice the taught communication skills through provider-initiated individual sessions with their patients. A total of 418 service providers completed assessments from baseline to 24-month. Linear mixed-effects regression models were used to compare self-reported short-term and sustained improvement in provider-patient interaction between the intervention and the control conditions. ResultsThe intervention group service providers perceived significantly greater short-term and sustained improvement in provider-patient interaction compared to the control group service providers (estimated difference (±SE): 1.20 (0.24) and 1.35 (0.33), respectively; p-values < 0.0001). Providers' baseline job satisfaction was significantly associated with a greater perceived improvement in provider-patient interaction for both periods (reg. coef. (±SE): 0.02 (0.01) and 0.04 (0.01) for short-term and sustained periods, respectively; p-values < 0.01). ConclusionStudy findings suggest that the intervention could be beneficial for improving perceived provider-patient interaction in MMT programs. Service providers' job satisfaction should be addressed in training programs for the improvement of provider-patient interaction.