Methadone Maintenance Treatment Clinics Research Articles

Assessing the impact of public funding in alleviating participant reduction and improving the retention rate in methadone maintenance treatment clinics in Taiwan: an interrupted time series analysis

Background Given the steady decline in patient numbers at methadone maintenance treatment (MMT) clinics in Taiwan since 2013, the government initiated Patients’ Medical Expenditure Supplements (PMES) in January 2019 and the MMT Clinics Accessibility Maintenance Program (MCAM) in September 2019. This study aims to evaluate the impact of the PMES and MCAM on the enrollment and retention of patients attending MMT clinics and whether there are differential impacts on MMT clinics with different capacities.Methods The monthly average number of daily participants and 3-month retention rate from 2013 to 2019 were extracted from MMT databases and subjected to single interrupted time series analysis. Pre-PMES (from February 2013 to December 2018) was contrasted with post-PMES, either from January 2019 to December 2019 for clinics funded solely by the PMES or from January 2019 to August 2019 for clinics with additional MCAM. Pre-MCAM (from January 2019 to August 2019) was contrasted with post-MCAM (from September 2019 to December 2019). Based on the monthly average number of daily patients in 2018, each MMT clinic was categorized as tiny (1–50), small (51–100), medium (101–150), or large (151–700) for subsequent stratification analysis.ResultsIn terms of participant numbers after the PMES intervention, a level elevation and slope increase were detected in the clinics at every scale except medium in MMT clinics funded solely by PMES. In MMT clinics with subsequent MCAM, a level elevation was only detected in small-scale clinics, and a slope increase in the participant numbers was detected in tiny- and small-scale clinics. The slope decrease was also detected in medium-scale clinics. In terms of the 3-month retention rate, a post-PMES level elevation was detected at almost every scale of the clinics, and a slope decrease was detected in the overall and tiny-scale clinics for both types of clinics.ConclusionsSupplementing the cost of a broad treatment repertoire enhances the enrollment of people with heroin use in MMTs. Further funding of human resources is vital for MMT clinics to keep up with the increasing numbers of participants and their retention.

“That Doesn’t Sound Like a Good Treatment”: Objections to Medications for Opioid Use Disorder (MOUD) and Moral Capital in Rural Indiana

Stigma associated with the use of the medications for opioid use disorder (MOUD), methadone and buprenorphine, is widespread and pervasive. I examine local perspectives toward MOUD in a rural Indiana county through 29 qualitative interviews with people with and without opioid use experience. Objections to Methadone Maintenance Treatment (MMT) voiced by interviewees centered on the perceived length of treatment, the continuation of an addict habitus or disposition, and the profit motives of the local MMT clinic. Local understandings of the temporal rationalities associated with methadone and buprenorphine treatment were used by interviewees in determinations of treatment legitimacy, as well as its moral acceptability. In rural contexts, the loss of moral capital known to accompany any association with illicit substance use can threaten economic survival for the poor. MOUD providers may want to carefully consider the meaning and experience of time with regard to treatment duration, as well as the moral landscapes of rural contexts, while creating treatment plans and communicating them to patients.

The risk assessment of relapse among newly enrolled participants in methadone maintenance treatment: A group-LASSO based Bayesian network study.

Relapse is a great barrier to improving the effectiveness of methadone maintenance treatment (MMT). Participants with different treatment durations could vary in their compliance with MMT, which may lead to different levels of relapse risk. This study aims to identify the risk factors for relapse and assess the relapse risk of MMT participants of different treatment durations. This retrospective study used data collected from seven MMT clinics in Guangdong Province, China, from January 2010 to April 2017. Newly enrolled participants who received 6 (n = 903) and 12 (n = 710) months of consecutive treatment with complete data were included. We selected significant risk factors for relapse through the group lasso regression and then incorporated them into Bayesian networks to reveal relationships between factors and predict the relapse risk. The results showed that participants who received 6-month treatment had a lower relapse rate (32.0%) than those of 12-month treatment (39.0%, P < 0.05). Factors including personal living status and daily methadone dose were only influential to those who received the 6-month treatment. However, age, age at the initial drug use, HIV infection status, sexual behaviors, and continuous treatment days were common factors of both durations. The highest relapse risk for those after the 6-month treatment was inferred as 66.7% while that of the 12-month treatment was 83.3%. Farmers and those who have high accessibility to MMT services may require additional attention. It is necessary to implement targeted interventions and education based on the treatment durations of participants to decrease the relapse rate. Meanwhile, those about HIV/sexually transmitted infection prevention and anti-narcotics should be held in the whole process.

Treatment Satisfaction Questionnaire for Medication (TSQM Version II): A Psychometric Properties Analysis

Background: Methadone or buprenorphine maintenance therapy is an effective treatment for opioid dependence. Since the satisfaction of patients under methadone maintenance treatment (MMT) plays an important role in their therapeutic success, it seems important to evaluate the satisfaction of methadone usage using multidimensional psychometric tools. Objectives: The current study aimed to investigate the psychometric properties of the Persian version of the Treatment Satisfaction Questionnaire for Medication (TSQM) version II. Patients and Methods: This cross‑sectional study was carried out on 288 opioid-dependent patients of Shahid Beheshti MMT clinic in Kerman, Iran, selected using the convenience sampling method. The data were collected using a questionnaire containing the demographic characteristics of the participants and the Persian version of the TSQM version II containing 11 items in four subscales of effectiveness, side effects, convenience of use, and overall satisfaction. The sum of the scores of each subscale is displayed as a number from 0 to 100. The face and content validity of the questionnaire was confirmed. The construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The internal consistency and repeatability of the TSQM version II were determined using Cronbach’s alpha and test-retest methods, respectively. LISREL software (version 8.8) and SPSS software (version 20.0) were used to analyze the data. Results: The sample with the male majority of 85% had a mean age of 46.24 ± 11.5 years. As a measure of internal consistency, Cronbach’s alpha of the Persian version of the TSQM version II was 0.8. The repeatability of the questionnaire using the test-retest method was calculated at 0.9. The EFA revealed the adequacy of sampling and justifiability of the analysis (Kaiser‑Meyer‑Olkin = 0.82, P = 0.001, χ2 = 1507.02, df = 28). In CFA, the goodness of fit was at an appropriate level. Conclusions: The TSQM Persian version can be used as an effective and consistent tool to assess treatment satisfaction in clinical settings.

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.

Exploration of dose tapering strategies for methadone maintenance treatment based on relapse risks: A subpopulation treatment effect pattern plot (STEPP) analysis

BackgroundHalf of methadone maintenance treatment (MMT) participants experience a tapering phase, however, the guidelines vary from country to country and lack individualized strategies based on relapse risk. A detailed and individualized tapering strategy is needed in China. This study aims to explore dose tapering strategies for Chinese individuals with different relapse risks. MethodsA retrospective study was conducted from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 549 participants. The end point was the first relapse within 12 months of the start of tapering. Relapse risks before tapering for each participant were determined from a Cox model. ResultsOut of 549 participants, 173 (31.5 %) relapsed within 12 months after tapering. Findings indicated that a taper dose of less than 5 mg/week is better than other taper doses. Subpopulation treatment effect pattern plot (STEPP) methodology revealed different tapering strategies benefit participants according to relapse risk before tapering. Overall, findings indicated that a less than 5 mg/week reduction in MMT dose is better than reductions of other amounts. For participants with a low relapse risk before tapering, a reduction of less than 2.5 mg/week in MMT dose is better than a 2.5–5 mg/week reduction. ConclusionsA taper dose of less than 5 mg/week appears to be the best dose tapering strategy for Chinese participants. Furthermore, for participants with a low relapse risk, a more gradual taper dose (less than 2.5 mg/week) works better than 2.5–5 mg/week. This benefit was not seen in participants with a high relapse risk before tapering.

Adaptation of a Problem-solving Program (Friendship Bench) to Treat Common Mental Disorders Among People Living With HIV and AIDS and on Methadone Maintenance Treatment in Vietnam: Formative Study.

BackgroundThe prevalence of common mental disorders (CMDs) among people living with HIV and people who inject drugs is high worldwide and in Vietnam. However, few evidence-informed CMD programs for people living with HIV who inject drugs have been adapted for use in Vietnam. We adapted the Friendship Bench (FB), a problem-solving therapy (PST)–based program that was successfully implemented among patients with CMDs in primary health settings in Zimbabwe and Malawi for use among people living with HIV on methadone maintenance treatment (MMT) with CMDs in Hanoi, Vietnam.ObjectiveThis study aimed to describe the adaptation process with a detailed presentation of 4 phases from the third (adaptation) to the sixth (integration) of the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) framework.MethodsThe adaptation phase followed a qualitative study design to explore symptoms of CMDs, facilitators, and barriers to conducting FB for people living with HIV on MMT in Vietnam, and patient, provider, and caretaker concerns about FB. In the production phase, we revised the original program manual and developed illustrated PST cases. In the topical expert and integration phases, 2 investigators (BNG and BWP) and 3 subject matter experts (RV, DC, and GML) reviewed the manual, with reviewer comments incorporated in the final, revised manual to be used in the training. The draft program will be used in the training and testing phases.ResultsThe study was methodologically aligned with the ADAPT-ITT goals as we chose a proven, effective program for adaptation. Insights from the adaptation phase addressed the who, where, when, and how of FB program implementation in the MMT clinics. The ADAPT-ITT framework guided the appropriate adaptation of the program manual while maintaining the core components of the PST of the original program throughout counseling techniques in all program sessions. The deliverable of this study was an adapted FB manual to be used for training and piloting to make a final program manual.ConclusionsThis study successfully illustrated the process of operationalizing the ADAPT-ITT framework to adapt a mental health program in Vietnam. This study selected and culturally adapted an evidence-informed PST program to improve CMDs among people living with HIV on MMT in Vietnam. This adapted program has the potential to effectively address CMDs among people living with HIV on MMT in Vietnam.Trial RegistrationClinicalTrials.gov NCT04790201; https://clinicaltrials.gov/ct2/show/NCT04790201

Smartphone Ownership, Smartphone Utilization, and Interest in Using Mental Health Apps to Address Substance Use Disorders: Literature Review and Cross-sectional Survey Study Across Two Sites.

BackgroundIn recent years, there has been increasing interest in implementing digital technologies to diagnose, monitor, and intervene in substance use disorders. Smartphones are now a vehicle for facilitating telepsychiatry visits, measuring health metrics, and communicating with health care professionals. In light of the COVID-19 pandemic and the movement toward web-based and hybrid clinic visits and meetings, it has become especially salient to assess phone ownership among individuals with substance use disorders and their comfort in navigating phone functionality and using phones for mental health purposes.ObjectiveThe aims of this study were to summarize the current literature around smartphone ownership, smartphone utilization, and the acceptability of using smartphones for mental health purposes and assess these variables across two disparate substance use treatment sites.MethodsWe performed a focused literature review via a search of two academic databases (PubMed and Google Scholar) for publications since 2007 on the topics of smartphone ownership, smartphone utilization, and the acceptability of using mobile apps for mental health purposes among the substance use population. Additionally, we conducted a cross-sectional survey study that included 51 participants across two sites in New England—an inpatient detoxification unit that predominantly treats patients with alcohol use disorder and an outpatient methadone maintenance treatment clinic.ResultsPrior studies indicated that mobile phone ownership among the substance use population between 2013 and 2019 ranged from 83% to 94%, while smartphone ownership ranged from 57% to 94%. The results from our study across the two sites indicated 96% (49/51) mobile phone ownership and 92% (47/51) smartphone ownership among the substance use population. Although most (43/49, 88%) patients across both sites reported currently using apps on their phone, a minority (19/48, 40%) reported previously using any apps for mental health purposes. More than half of the participants reported feeling at least neutrally comfortable with a mental health app gathering information regarding appointment reminders (32/48, 67%), medication reminders (33/48, 69%), and symptom surveys (26/45, 58%). Most patients were concerned about privacy (34/51, 67%) and felt uncomfortable with an app gathering location (29/47, 62%) and social (27/47, 57%) information for health care purposes.ConclusionsThe majority of respondents reported owning a mobile phone (49/51, 96%) and smartphone (47/51, 92%), consistent with prior studies. Many respondents felt comfortable with mental health apps gathering most forms of personal information and with communicating with their clinician about their mental health. The differential results from the two sites, namely greater concerns about the cost of mental health apps among the methadone maintenance treatment cohort and less experience with downloading apps among the older inpatient detoxification cohort, may indicate that clinicians should tailor technological interventions based on local demographics and practice sites and that there is likely not a one-size-fits-all digital psychiatry solution.

Community-based and HIV integrated testing for hepatitis B and C among key populations in Vietnam.

Community-based and HIV integrated testing for hepatitis B and C among key populations in Vietnam.

A cross-sectional study of physical activity attitudes and preferences of individuals with opioid use disorder

Opioid use disorder (OUD) is a public health crisis. Methadone maintenance treatment (MMT) is an effective treatment for OUD; but even with MMT, treatment retention is poor, and relapse rates are high. Physical activity (PA) has been shown to improve retention and relapse rates among individuals in substance use disorder treatment. We conducted a cross-sectional study to explore PA attitudes (i.e., barriers and benefits to PA, PA self-efficacy, PA-related affect), PA preferences, and self-reported PA among adults with OUD who were in MMT. A total of 60 adults (Mean age 35.7 [SD = 9.7]) were recruited from MMT clinics. The majority were male (51.7%) and White (71.75%). Participants indicated a high level of perceived benefits to PA, moderate level of perceived barriers to PA, moderate level of self-efficacy to overcome barriers to PA, and PA as enjoyable. PA preferences were identified and considerations for future PA intervention research in this population are discussed. These findings add to the limited body of research on PA attitudes and preferences in adults receiving MMT and suggest continued work in this area could inform tailored PA intervention design for this vulnerable population.

The prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya

BackgroundCannabis use during methadone treatment may negatively impact treatment outcomes. The aim of this study was to determine the prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya.MethodsThis was a retrospective study of 874 patients on methadone therapy at a methadone maintenance treatment clinic in Nairobi, Kenya from December 2014 to November 2018. Data on sociodemographic characteristics and drug use patterns based on urine drug screens was collected from patient files. Data was analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 23.0.ResultsPoint prevalence of cannabis use was 85.8% (95% CI, 83.3 – 88.0) at baseline and 62.7% (95% CI, 59.5 – 65.8) during follow-up. A pattern of polysubstance use was observed where opioids, cannabis and benzodiazepines were the most commonly used drugs. The mean age of the patients was 35.3 (SD 9.0) years with the majority being male, unemployed (76%), (51.4%) had reached primary level of education, and (48.5%) were divorced or separated. University education was associated with reduced risk for cannabis use OR = 0.1 (95% CI, 0.02-0.8, p = 0.031).ConclusionCannabis use is prevalent among patients attending a methadone treatment clinic in Kenya, suggesting need for targeted interventions to address the problem of cannabis use during methadone treatment.

A cross-sectional study on the association between oral health and vitamin D levels in methadone maintenance treatment program of Iranian population

Aims: The aim of this study was to investigate the relationship between oral health and Vitamin D levels in patients undergoing methadone maintenance treatment in addiction treatment centers in Kashan. Materials and Methods: This cross-sectional study was performed on 202 patients aged 18–60 years who were referred to methadone maintenance treatment clinics in Kashan. The measurement tool included a demographic information checklist and a modified oral health form of the World Health Organization. 2cc of blood was taken from patients to measure Vitamin D levels. Findings: Out of 181 patients in the study, 73.8% of patients had a methadone dose of <20 cc per day. One hundred twenty-six patients had a history of drug use. In 86.4% of patients, Vitamin D deficiencies were observed. In these patients, moderate gingival problems and moderate-to-severe dental plaque were 60.2% and 71.9%, respectively. Furthermore, the range of decayed, missing, and filled teeth (DMFT) index in these patients was 23.57 ± 7.90. No significant relationship was indicated between DMFT index and Vitamin D level. Conclusions: It is difficult to determine the main causes of oral problems among addicts. Apart from the direct effects of addiction, these patients exhibit a wide range of unhealthy behaviors such as poor oral hygiene, high sugar intake, and poor nutrition. On the other hand, most patients experience reduces in Vitamin D status.

Investigating Cognitive Functions in Methadone Users in Comparison with Methadone and Methamphetamine Users and Control Group

BackgroundCognitive impairment in drug users is a marker for predicting recurrence and poorer adherence to treatment. The purpose of this study was to compare the cognitive function in three groups of methadone users methadone maintenance treatment (MMT), compared to methadone and methamphetamine (MAMP) users (MMT + MAMP) and healthy people (control group).MethodsThree groups of 90 people including 30 users of MMT, 30 users of MMT + MAMP, and 30 healthy persons participated in this cross-sectional and purposeful study. The study was performed on outpatients of MMT Clinic of Psychiatric Hospital in Kerman, Iran. The demographic and related data questionnaire was filled out. In addition, Persian version of the Brief Assessment of Cognition in Schizophrenia (BACS) was used to assess cognitive function.FindingsThe mean of total number of scores and all BACS subscales were significantly better in control group than the other two groups of patients. Moreover, not only the mean of total number of BACS was significantly different between two substance abuser groups, but also there was a significant difference between them on verbal memory, digit sequencing, and token motor test, with MMT + MAMP group performing worse than MMT group.ConclusionConcomitant use of opioids and stimulant substance such as MAMP results in cumulative toxic effect of them on brain and cognitive functions.

A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment.

We examined the feasibility (i.e., single-session attendance) of conducting 3 counselor-delivered nonpharmacological pain management intervention (NPMI) groups in methadone maintenance treatment (MMT): (1) Coping with Pain, an intervention based on cognitive-behavioral therapy, (2) Wii-Covery, an exergame intervention to facilitate exercise, and (3) Juggling Group, an intervention to promote social inclusion and reduce stress. We examined pre-post session changes in pain and mood associated with group attendance. Over 1 month at an MMT clinic with 1800 patients, each NPMI group was offered daily Monday-Friday and 1 was offered on Saturdays. A standardized but unvalidated measure was administered before and after sessions to assess acute changes in current pain intensity and mood states. Paired t-tests with Bonferroni corrections were performed for each NPMI group (P < 0.0007 [.05/7]). About 452 patients (67% male, 84% White, mean age, 40) attended at least 1 NPMI group. About 57% reported current chronic pain. Attendance at any NPMI group (for the whole sample and the subset with chronic pain) was significantly associated with acute reductions in current pain intensity, anxiety, depression, and stress, and acute increases in current energy and happiness. Attendance at Coping with Pain and Juggling Group was also associated with acute increases in compassion. Coping with Pain, Wii-Covery, and Juggling Group are feasible to conduct in MMT, and acute improvements in current pain intensity and specific mood states associated with a single session attendance point to the importance of examining systematically the efficacy of these and other NPMIs in MMT.

A pilot randomized clinical trial of mindfulness-oriented recovery enhancement as an adjunct to methadone treatment for people with opioid use disorder and chronic pain: Impact on illicit drug use, health, and well-being

BackgroundChronic pain is highly prevalent among people in methadone maintenance treatment (MMT) for opioid use disorder and is known to be an important contributor to treatment discontinuation and opioid relapse. Mindfulness-Oriented Recovery Enhancement (MORE) is one of the few interventions developed and tested as an integrated treatment to simultaneously address both pain and illicit opioid use; however, this study is the first to evaluate MORE as an adjunct to MMT. MethodsRandomized individuals in MMT (N = 30) received MORE plus methadone TAU (n = 15) or methadone TAU, only (n = 15). Participants in the MORE arm received their MMT, as usual, and attended eight, weekly, two-hour MORE groups at their MMT clinics. Participants in the TAU arm received their MMT, as usual, and group or individual counseling, as required by the clinic. TAU counseling consisted of relapse prevention, cognitive-behavioral therapy, and supportive treatment. TAU participants did not receive any mindfulness-based intervention. Participants completed assessments at baseline, post-treatment (i.e., 8-weeks post-baseline), and follow-up (i.e., 16-weeks post-baseline). ResultsParticipants in MORE evidenced significantly fewer baseline adjusted days of illicit drug use and significantly lower levels of craving through 16-week follow-up compared to TAU. Also, Participants in MORE reported significantly lower levels of pain, physical and emotional limitations, depression, and anxiety through 16-week follow-up compared to TAU. Conversely, participants in MORE reported significantly higher levels of well-being, vitality, and social functioning through 16-week follow-up compared to TAU. ConclusionMORE could be an effective adjunct to MMT, and larger trials are warranted.

A Virtual Reality Meditative Intervention Modulates Pain and the Pain Neuromatrix in Patients with Opioid Use Disorder.

Standard of care for opioid use disorder (OUD) includes medication and counseling. However, there is an unmet need for complementary approaches to treat OUD patients coping with pain; furthermore, few studies have probed neurobiological features of pain or its management during OUD treatment. This preliminary study examines neurobiological and behavioral effects of a virtual reality-based meditative intervention in patients undergoing methadone maintenance treatment (MMT). Prospective, non-blinded, single-arm, 12-week intervention with standardized assessments. Academic research laboratory affiliated with an on-site MMT clinic. Fifteen (11 female) MMT patients completed a virtual reality, therapist-guided meditative intervention that included breathing and relaxation exercisessessions were scheduled twice weekly. Assessments included functional magnetic resonance imaging (fMRI) of pain neuromatrix activation and connectivity (pre- and post-intervention), saliva cortisol and C-reactive protein (CRP) at baseline and weeks 4, 8 and 12; and self-reported pain and affective symptoms before and after each intervention session. After each intervention session (relative to pre-session), ratings of pain, opioid craving, anxiety and depression (but not anger) decreased. Saliva cortisol (but not CRP) levels decreased from pre- to post-session. From pre- to post-intervention fMRI assessments, pain task-related left postcentral gyrus (PCG) activation decreased. At baseline, PCG showed positive connectivity with other regions of the pain neuromatrix, but this pattern changed post-intervention. These preliminary findings demonstrate feasibility, therapeutic promise, and brain basis of a meditative intervention for OUD patients undergoing MMT.

Related factors and interaction on hepatitis C virus infection in patients receiving methadone maintenance treatment in Taiyuan

Objective: To explore the prevalence of hepatitis C virus (HCV) infection, influence factors and interaction on HCV infection in patients receiving methadone maintenance treatment (MMT) in Taiyuan. Methods: Between April-June 2019, three MMT clinics in Taiyuan were selected to conduct a face-to-face questionnaire survey among MMT patients to collect the information about their socio-demographic characteristics, drug use, MMT, sexual behavior and health status. Software EpiData 3.1 was used for real-time double entry to establish the database. Software SAS 9.4 was used to analyze the data, and χ2 test was used for univariate analysis and logistic regression model was used for multivariate and interaction analyses. Results: A total of 903 subjects were surveyed among MMT patients, the male to female ratio of was 7.21∶1(743∶103), and the rate of HCV infection was 12.53% (106/846). After adjusting for the confounding factors, being women (OR=1.936, 95%CI: 1.023-3.662), having sex with drug users (OR=2.073, 95%CI: 1.110-3.871) and injection drug use (OR=7.737, 95%CI: 4.614-12.973) might be the risk factors for HCV infection in patients receiving MMT. The results showed that there were multiplicative interactions among women, having sex with drug user and injection drug use on HCV infection. Conclusions: Being women, having sex with drug user and injection drug use were associated with higher risk for HCV infection in patients receiving MMT in Taiyuan. There were multiplication interactions between being women and having sex with drug user, being female and injection drug use, and having sex with drug use and injection drug use on HCV infection.

Review, Documentation, Assessment of Treatment, and Harm Reduction Programs of Substance Use Disorder in Iranian Prisons

Objectives: This study aims to assess the implementation of drug-related harm reduction programs in Iranian prisons and suggest solutions for their improvement. Methods: This study was conducted in three steps. First, library method was used for collecting data from the central library of Iran’s Prisons, Security and Corrective Measures Organization. In the second step, performance indicators were extracted based on the results of first step and two researcher-made checklists were designed. Finally, a field visit and a semi-structured interview with the authorities involved in the treatment and harm reduction services were carried out. Results: In most of prisons, drug-related harm reduction programs were underway. Despite a lack of human resources and budget at the beginning, the quality of measures was gradually increased and the attitude of authorities was improved. Methadone Maintenance Treatment and Triangular Clinics were the most common harm reduction programs, in addition to HIV and tuberculosis screening programs in collaboration with medical sciences universities. The program continued despite the change of officials. Conclusion: Harm reduction programs are able to reduce infection diseases, self-harm and violent behaviors in prisons of Iran. Cultural programs along with other harm reduction programs, briefings and seeking support from the authorities can greatly help with continuation of the programs in prisons. By eliminating the shortage of manpower and redefining the security areas for ordinary prisoners, it will be possible to make better use of the facilities of universities and research centers.