Methadone Maintenance Treatment Clinics In China Research Articles

Effect of Acupuncture for Methadone Reduction : A Randomized Clinical Trial.

Methadone maintenance treatment (MMT) is effective for managing opioid use disorder, but adverse effects mean that optimal therapy occurs with the lowest dose that controls opioid craving. To assess the efficacy of acupuncture versus sham acupuncture on methadone dose reduction. Multicenter, 2-group, randomized, sham-controlled trial. (Chinese Clinical Trial Registry: ChiCTR2200058123). 6 MMT clinics in China. Adults aged 65 years or younger with opioid use disorder who attended clinic daily and had been using MMT for at least 6 weeks. Acupuncture or sham acupuncture 3 times a week for 8 weeks. The 2 primary outcomes were the proportion of participants who achieved a reduction in methadone dose of 20% or more compared with baseline and opioid craving, which was measured by the change from baseline on a 100-mm visual analogue scale (VAS). Of 118 eligible participants, 60 were randomly assigned to acupuncture and 58 were randomly assigned to sham acupuncture (2 did not receive acupuncture). At week 8, more patients reduced their methadone dose 20% or more with acupuncture than with sham acupuncture (37 [62%] vs. 16 [29%]; risk difference, 32% [97.5% CI, 13% to 52%]; P < 0.001). In addition, acupuncture was more effective in decreasing opioid craving than sham acupuncture with a mean difference of -11.7 mm VAS (CI, -18.7 to -4.8 mm; P < 0.001). No serious adverse events occurred. There were no notable differences between study groups when participants were asked which type of acupuncture they received. Fixed acupuncture protocol limited personalization and only 12 weeks of follow-up after stopping acupuncture. Eight weeks of acupuncture were superior to sham acupuncture in reducing methadone dose and decreasing opioid craving. National Natural Science Foundation of China.

Strategies to control HIV and HCV in methadone maintenance treatment in Guangdong Province, China: a system dynamic modeling study

BackgroundHuman immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among methadone maintenance treatment (MMT) participants remain high. Optimized HIV and HCV prevention strategies for MMT clinics in resource-limited regions are urgently needed. This study aims to develop an MMT system dynamic model (SDM) to compare and optimize HIV and HCV control strategies in the MMT system.MethodsWe developed an MMT-SDM structure based on literature reviews. Model parameters were estimated from a cohort study, cross-sectional surveys and literature reviews. We further calibrated model outputs to historical data of HIV and HCV prevalence among MMT participants in 13 MMT clinics of Guangdong Province. Lastly, we simulated the impact of integrated interventions on HIV and HCV incidence among MMT participants using the MMT-SDM.ResultsThe MMT-SDM comprises MMT clinics, MMT participants, detoxification centers, and HIV and HCV transmission, testing and treatment systems. We determined that condom promotion was the most effective way to reduce HIV infection (2013-2020: 2.86% to 1.76%) in MMT setting, followed by needle exchange program (2013-2020: 2.86% to 2.56%), psychological counseling (2013-2020: 2.86% to 2.71%) and contingency management (2013-2020: 2.86% to 2.72%). Health education had marginal impact on reducing HIV incidence among MMT participants (2013-2020:2.86% to 2.84%) from 2013 to 2020. By contrast, psychological counseling (2013-2020: 7.54% to 2.42%) and contingency management (2013-2020: 7.54% to 2.96%) had been shown to be the most effective interventions to reduce HCV incidence among MMT participants, followed by needle exchange program (2013-2020: 7.54% to 5.76%), health education (2013-2020: 7.54% to 6.35%), and condom promotion program (2013-2020: 7.54% to 6.40%). Notably, HCV treatment reduced HCV incidence by 0.32% (2013-2020: 7.54% to 7.22%).ConclusionsIn conclusion, we generated a valuable system dynamic model to analyze the Chinese MMT system and to guide the decision-making process to further improve this system. This study underscores the importance of promoting condom use in MMT clinics and integrating psychosocial interventions to reduce HIV and HCV infections in MMT clinics in China.

Resilience associated with mental health problems among methadone maintenance treatment patients in Guangzhou, China

ABSTRACTA considerable proportion of methadone maintenance treatment (MMT) clients have experienced mental health problems (e.g., depression and anxiety), and poor mental health status is associated with HIV-related risk behaviors and treatment drop-out. Resilience is known to be a protective factor for mental health problems but is not studied among MMT clients in China. This study aimed to explore the relationship between resilience and mental health problems (depression, anxiety and stress) among clients of community-based MMT clinics in China. A total of 208 MMT clients completed the face-to-face interview conducted at 4 of 11 MMT clinics in Guangzhou. The Chinese short version of Depression Anxiety Stress Scale (DASS-21) was used to assess the presence of depressive, anxiety and stress symptoms, and the Connor–Davidson Resilience Scale (CD-RISC) was used to measure resilience. Logistic regression models were fit in data analyses. Of all participants, 12.8%, 19.5% and 8.3% had depression, anxiety and stress, respectively. The mean resilience score was 57.6 (SD = 15.9). In the univariate analyses, resilience was negatively associated with two studied mental health problems (depression and anxiety, ORu = 0.96 and 0.96, p < .01). In multivariate models adjusting for both background and other psycho-social factors, resilience was independently associated with probable depression (ORa = 0.97, 95% CI: 0.93–0.99) and anxiety (ORa = 0.96, 95% CI: 0.94–0.99). Resilience was independently associated with depression and anxiety. As resilience is changeable, interventions targeting mental health problems of MMT users should consider resilience as an important part in the designing of such interventions.

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.

Who uses methadone services in China? Monitoring the world's largest methadone programme.

To describe the data collected by the Chinese methadone maintenance treatment (MMT) system and the characteristics of clients entering the programme. Descriptive study using routinely collected data from the MMT data management system for the period March 2004 and March 2010. All MMT clinics in China. Clients who enrolled for services between March 2004 and March 2010. Routinely collected data included: demographic information; drug use, sexual and criminal behaviours; status of infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV) and syphilis; random urine-opiate test results; and the daily methadone dose received. Differences among clients by year were examined. During the period examined, there were 251,974 clients attending 684 clinics in 27 provinces. Overall, the mean age was 34.4 years, 83.8% were male, 70.2% were unemployed, 75% had ever injected drugs, 17% had shared needles and 7.4% were HIV-positive. The profile of clients changed over time, with fewer HIV-positive individuals, fewer injecting drug users, fewer needle-sharers, fewer females and fewer unemployed. Half the clients dropped out within 6 months. The average final dose received was 49.4 mg. The estimated probability of interrupting treatment before 6 months was 52.5%. The profile of clients enrolling in methadone maintenance treatment in China is continually changing and appears to be associated with reduced risk of HIV. High dropout in the programme may limit its effectiveness. The availability of a centralized, real-time data system was extremely useful for monitoring the progress of the Chinese methadone maintenance treatment programme.

Retention and its predictors among methadone maintenance treatment clients in China: A six-year cohort study

BackgroundTo investigate factors associated with retention among the first cohort of drug users attending methadone maintenance treatment (MMT) clinics in China. MethodsA six-year cohort of 1511 drug users was enrolled in the first 8 MMT clinics in China in 2004 and followed between March, 2004 and December, 2010. Six-year retention rates were calculated and compared by methadone dosage, clinic location, and length of follow-up. Factors associated with retention were evaluated using Cox proportional hazard regression models. ResultsThe overall retention rate over 6-year was 35.7%. Highest drop-out occurred within the first 12 months of treatment. The retention rates for the 6-year by low (≤30mg/day), medium (31–60mg/day), and high (>60mg/day) methadone dosage groups were 20.8%, 34.8% and 53.2%, respectively (p<0.001). The highest 6-year retention rate among eight clinics was 43.8%, while the lowest one was 17.7% (p<0.001). The results from Cox proportional hazard models indicate that clients having >30mg daily methadone dosage (p<0.001), having relatives receiving MMT (p=0.027), and having >10% urine morphine positive result (p<0.001) were more likely to be retained in MMT over the six-year period. It has also found that drug injection (p=0.005) and needle sharing (p<0.0001) were significantly associated with better retention. ConclusionsHealth workers should adjust individuals’ methadone dosages as a method to prevent early treatment termination. Further studies are needed to explore the impact of severity of opiate addiction on long-term retention of MMT clients. Careful assessment of drug users upon MMT enrollment may be helpful for providing additional care to clients.

Epidemiology of syphilis infection among drug users at methadone maintenance treatment clinics in China: systematic review and meta-analysis

Illicit drug trade has re-emerged in China since 1979 and the number of drug addicts had increased. Syphilis is mainly spread through sexual contact and blood. The incidence of syphilis is high among drug users. Methadone maintenance treatment (MMT) clinics have been implemented in China since 2004. The aim of this study was to estimate the prevalence and risk factors of syphilis among drug users at MMT clinics in China between 2004 and 2013. Chinese and English databases (CBM, CNKI, Weipu, Pubmed) of literature were searched for studies reporting syphilis among drug users in MMT clinics from 2004 to 2013. The prevalence estimates and risk factors were summarized through a systematic review and meta-analysis of published literatures. In all, 29 eligible articles with a total of 8899 drug users, were selected in this review. The pooled prevalence of syphilis infection was 7.78% (95%CI: 5.83%-9.99%). The meta-analyses demonstrated significant differences in syphilis infection rates between men and women (OR = 0.34 [95%CI: 0.26-0.45]) but not between drug users and non-intravenous drug users (OR = 0.82 [95%CI: 0.51-1.32]). Enhanced detection of syphilis and health promotion is warranted in MMT clinics in China.

Evaluation on the long-term effectiveness among the first set eight methadone maintenance treatment clinics in China

To evaluate the long-term effectiveness of the first set 8 methadone maintenance treatment (MMT) clinics in China. Repeated cross-sectional surveys were conducted on the first month after the enrollment and 5 years later, among drug users who received MMT, using a standard questionnaire. Data on demographic characteristics, HIV-related high-risk behaviors, criminal records associated with drug use and related family/social functions were collected and analyzed. There were 252 and 195 participants being interviewed at the baseline and the 5-year surveys, respectively. Of them, 66 participants were involved in both surveys. There was no significant differences on factors as ethnicity, level of education, working status, marital status and living status (P > 0.05) between the baseline and the 5-year surveys. Compared with data from the baseline survey, participants' behavior on drug abuse (100.0% vs. 24.1%, P < 0.001), needle sharing behavior (19.4% vs. 0.0%, P < 0.001), and exchanging sex for drugs (34.5% vs. 0.0%, P < 0.001) had significant decreases at the 5-year survey. Rates on condom use (10.6% vs. 25.0%, P = 0.004), and having jobs (27.8% vs. 47.7%, P < 0.001) had been improved significantly, while self-reported criminal cases related to drug use (15.1% vs. 1.5%, P < 0.001) and the contacts with drug users (88.9% vs. 31.3%, P < 0.001) had been significantly reduced after joining the MMT program. MMT could play an active role in reducing the HIV-related high-risk behaviors, criminal cases associated with drug abuse as well as enhancing the family and social functions of the MMT patients. Providing high quality service to the MMT clinic and trying to keep the drug users stick to the program remain difficult. It was also important to improve the training programs for staff working at the MMT clinics.

Quality of life of outpatients in methadone maintenance treatment clinics.

To explore the quality of life (QOL) changes in methadone maintenance treatment (MMT) clinic outpatients in the first 3 months of treatment. A cohort study was conducted in 5 MMT clinics for more than 3 months, and the QOL of outpatients was measured by the QOL instrument for drug addicts at days 1, 30, and 90 to explore QOL changes. Repeated measurement analysis method was used for data analysis. One hundred seventy-two outpatients in 5 MMT clinics were recruited, and 142 (82.65%) remained in treatment at day 90. The Cronbach alpha coefficient of the QOL instrument for drug addicts used in our study is 0.96, with a range of 0.74-0.94 for all subscales. The QOL scores of drug addicts improved from day 1 to day 30 (X(beginning) = 51.92, X(first month) = 74.83, P < 0.01), and all subscale scores improved significantly (P < 0.01). However, QOL improved little from day 30 to day 90, (X(first month) = 74.83, X(third month) = 75.99, P < 0.01). Physical health and mental health improved significantly during the second and third month, whereas all other subscale scores did not (P > 0.05). MMT is helpful in improving the QOL of outpatients in MMT clinics in China.