Methadone Maintenance Treatment Clinics Research Articles

Risk factors associated with HIV/HCV infection among entrants in methadone maintenance treatment clinics in China: A systematic review and meta-analysis

Background: Methadone maintenance treatment (MMT) has rapidly expanded in China, from 8 pilot sites to 696 clinics covering 27 provinces, during 2004–2010. This study evaluates the demographic characteristics and drug use behaviors associated with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) infections among MMT entrants through a systematic review and meta-analysis of published literature. Methods: Thirty-nine eligible articles (1 in English and 38 in Chinese) were selected for this review. We extracted the relevant indicator information from all eligible studies and performed meta-analyses, by stratifying according to sex of the participants, age groups and drug use behaviors. Five provinces (i.e., Yunnan, Guizhou, Sichuan, Guangxi and Xinjiang) with the population size of HIV-infected drug users greater than 10,000 were defined as high transmission areas (HTAs) for HIV infection; whereas the remaining twenty-six Chinese provinces were considered as low transmission areas (LTAs). Results: The odds of being infected by HIV among male drug users were significantly higher than for females in high transmission areas (OR=1.49, 95% CI: 1.11–1.99, k=9), while the opposite results were observed in low transmission areas (OR=0.46, 0.27–0.79, k=11). In comparison, no significant differences in risk behaviors were found between sexes in HTAs and LTAs. Younger age was not associated with risk of HIV infection, but was associated with higher risk of HCV infection (<30 years OR=1.88; 30–40 years OR=2.21, compared with >40 years, k=17). Risk of HIV infection was higher among injectors than non-injectors (OR=4.29, 2.70–6.79, k=14) and for those who inject, there was greater risk among sharers than non-sharers (OR=2.47, 1.44–4.23, k=4). Similar patterns were also observed in HCV infection (injectors: OR=10.82, 7.60–15.40; sharers: OR=3.41, 2.56–4.54, k=7). Conclusions: Characteristics of MMT entrants positive for HIV or HCV in China vary by disease types, geographical region, sex, age, and injecting behavior. These factors need to be considered in targeted interventions for MMT participants, such as age-specific health education and psychological treatment, antiretroviral therapy and needle-syringe exchange programs.

HIV and HCV prevalence among entrants to methadone maintenance treatment clinics in China: a systematic review and meta-analysis

BackgroundMethadone maintenance treatment (MMT) was implemented in China since 2004. It was initiated in 8 pilot clinics and subsequently expanded to 738 clinics by the end of 2011. Numerous individual research studies have been conducted to estimate HIV and HCV prevalence among MMT clients but an overview of the epidemics in relations to MMT remains unclear. The aim of this study is to estimate the magnitude and changing trends of HIV, HCV and HIV-HCV co-infections among entry clients to MMT clinics in China during 2004-2010.MethodsChinese and English databases of literature were searched for studies reporting HIV, HCV and co-infection prevalence among MMT clients in China from 2004 to 2010. The prevalence estimates were summarized through a systematic review and meta-analysis of published literatures.ResultsNinety eligible articles were selected in this review (2 in English and 88 in Chinese). Nationally, pooled prevalence of HIV-HCV and HIV-HCV co-infection among MMT clients was 6.0% (95%CI: 4.7%-7.7%), 60.1% (95%CI: 52.8%-67.0%) and 4.6% (95%CI: 2.9%-7.2%), respectively. No significant temporal trend was found in pooled prevalence estimates. Study location is the major contributor of heterogeneities of both HIV and HCV prevalence among drug users in MMT.ConclusionsThere was no significant temporal trend in HIV and HCV prevalence among clients in MMT during 2004–2010. Prevalence of HCV is markedly higher than prevalence of HIV among MMT clients. It is recommended that health educational programs in China promote the earlier initiation and wider coverage of MMT among injecting drug users (IDUs), especially HIV-infected IDUs.

PMH22 Correlates of Dropout from Community-Based Methadone Maintenance Treatment Program in Indonesia

To study factors associated with risk of dropout among heroin addicts enrolled in a community-based methadone maintenance treatment (MMT) clinic in Solo, Central Java, Indonesia. This was an ambi-directional cohort study. The index date was patients' first entry identified from medical records. Patients enrolled from September 2009 were followed up until departure from the clinic or otherwise censored in May 2011. Other data collected were methadone doses, risk behaviour, and sociodemographic characteristics. Kaplan-Meier method was used to estimate retention rate and Cox proportional hazard regressions were used to determine factors associated with dropout from treatment. Ninety-eight patients aged 31.6 years old on average contributed to 14,804 person-days of folllow up. The retention rate was 24.2% after 21 months with median retention time of 78 days. The median and maximum dose were 43.1 mg and 150 mg, respectively. Multivariate analysis showed that methadone dose below 80 mg (HR=2.4, p=0.014, 95% CI=1.2-4.8) and absence of family support (HR=5.0, p<0.001, 95% CI=2.4-10.6) were significantly associated with risk of dropout. HIV status, overdose history, criminal record, duration of addiction, distance from clinic, marital status, and employment were not statistically significant predictors of dropout. Despite high prevalence of injecting drug users (IDUs) in the area, low retention rate of the MMT clinic indicates that the community-based program might have been suboptimally utilised or else poorly managed. Attaining maintenance phase at a minimum dose of 60 mg was insufficient to ensure compliance. Health workers should maintain relationships with patients' family to help support and monitor the treatment. Similar studies in hospital or correctional institution settings and/or other areas are needed to confirm the findings as well as economic analyses to anticipate waste of resources.

Misconceptions predict dropout and poor adherence prospectively among newly admitted first‐time methadone maintenance treatment clients in Guangzhou, China

To investigate the incidence of dropout and the prevalence of poor adherence among newly admitted first-time clients of methadone maintenance treatment (MMT) clinics, and the associations between MMT-related misconceptions and these two treatment outcomes. A cohort study (maximum follow-up period = 17.6 months) was conducted. Three of the nine MMT clinics in Guangzhou, China participated in the study. The sample included 158 newly admitted first-time MMT clients. Information collected included background characteristics, history of drug use, MMT-related misconceptions, dropout during the entire study period and poor adherence within the first 6 months since admission to MMT. Of all newly admitted MMT clients, 98.2% possessed at least one and 50.6% possessed all four types of MMT-related misconception; 51.3% had dropped out before the completion of the study [95% confidence interval (CI): 43.5-59.1%] and 62% exhibited poor adherence within the first 6 months since admission (95% CI: 54.2-69.6%). Adjusting for significant background variables, the number of misconceived responses predicted significantly both dropout [hazard ratio (HR) = 3.80 for two to three misconceived items, HR = 7.13 for four misconceived items, with zero to one misconceived item being the reference] and poor adherence within the first 6 months [relative risk (RR) = 4.13 for two to three misconceived items; RR = 4.40 for four misconceived items, with zero to one misconceived item being the reference. Among opiate addicts in China prescribed methadone maintenance therapy for the first time, misconceptions about this medication are prevalent and are associated with poor adherence to the medication regimen and a high a rate of dropout from the treatment programme.

Mortality and causes of death among users of methadone maintenance treatment in Israel, 1999–2008

ObjectivesTo determine all-cause and specific-causes mortality, in the years 1999–2008, among opioid-dependent users treated at methadone maintenance treatment (MMT) clinics in Israel and to compare the obtained results with data from relevant studies worldwide. MethodThe records of patients treated at MMT units were linked to the nationwide database of causes of death. Information about the Israeli general population from the Central Bureau of Statistics was used for comparison to match sex and age to the cohort under study. Crude mortality rates (CMRs) per 100 persons per year (PY) and standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated. ResultsThe overall CMR for MMT users was 1.49/100 PY (CI 1.40–1.59) and was not associated with gender, age at entering MMT, ethnicity, and immigrant status. The leading causes of mortality were sudden/undefined death (0.31/100 PY, CI 0.26–0.35), overdose (0.22/100 PY, CI 0.17–0.27), and cancer (0.15/100 PY, CI 0.12–0.18). The MMT users were 12.2 times more likely to die from all causes than people from the general population. Overall, our estimates were comparable with the figures pooled from relevant studies. ConclusionsThe results suggest that the excess mortality of MMT users is associated with an increased morbidity, which alone or in combination with service-related risks, lead to worse outcomes.

Duration of Methadone Maintenance Treatment During Pregnancy and Pregnancy Outcome Parameters in Women With Opiate Addiction

Methadone maintenance treatment (MMT) is the standard treatment of choice for pregnant opiate addicts; however, data on newborn outcomes are contradictory. We studied the effect of the timing of starting MMT and of MMT related drug abstinence on the outcome of newborns of former and current opiate-addicted pregnant women. All babies (excluding repeated deliveries) of all pregnant women who were admitted to 1 MMT clinic between 1993 and 2008 were studied. Former opiate-addicted women who became pregnant while already on MMT (full-pregnancy MMT, FP-MMT) and opiate-addicted women who only started MMT during pregnancy (partial-pregnancy MMT, PP-MMT) were retrospectively compared for birth weight and gestational age of newborns. Abstinence was defined as negative urine sample results for opiates, cocaine, amphetamines, benzodiazepine and cannabis during the month before delivery. We examined 59 newborn babies: 14 in the FP-MMT group and 45 in the PP-MMT group. The mean birth weight was 2733.2 ± 392.0 g versus 2240.0 ± 680.4 g respectively (F[1] = 6.6, P = 0.01). Abstinence was determined among 73.3% of the FP-MMT and 28.6% of the PP-MMT (P = 0.004). Gestational age was higher in the abstinence (37.9 ± 2.8 weeks) versus no-abstinence group (35.8 ± 4.6 weeks; F[1] = 4.4, P = 0.04). The best pregnancy outcome, characterized by a higher gestational and birth weight, was associated with a longer duration on MMT and substance abstinence, emphasizing the importance of MMT stabilization before and during pregnancy.

Misconceptions toward methadone maintenance treatment (MMT) and associated factors among new MMT users in Guangzhou, China

The methadone maintenance treatment (MMT) program is scaling up in China, but little is known about drug users' cognitions of MMT. To investigate the prevalence and associated factors of MMT-related misconceptions, a totally of 300 newly admitted MMT users were interviewed in three MMT clinics in Guangzhou. Four statements were used to assess MMT-related misconceptions. The results showed that the majority of participants misconceived that MMT is intended primarily for detoxification (92.3%), that one could be completely detoxified and quit using methadone after using it for 2–3months (64.2%), that MMT is not a long-term or even lifetime treatment (77.9%); and that one should attempt to reduce its treatment dosage as methadone is harmful to one's health (84.3%); 48.5% of the respondents possessed all four types of misconceptions. Prior experience of methadone use in voluntary drug detoxification centers (OR=1.82 to 2.55, p<0.05) was associated with some misconception items, whilst being introduced by some peer drug users or community members to use MMT (versus not being introduced by anyone; OR=0.38 to 0.50, p<0.05), having taken up HIV voluntary counseling and testing prior to admission (OR=0.52, p<0.05), and a higher HIV-related knowledge level (OR=0.38, p<0.05) were associated with lower likelihoods for possessing some of the misconceptions. The findings suggested that MMT-related misconceptions were very prevalent among newly recruited MMT users in China. Misconceptions are potential factors causing drop-outs. Interventions targeting such misconceptions are greatly warranted.

Efficacy of contingency management in improving retention and compliance to methadone maintenance treatment: a random controlled study.

BackgroundCompliance with methadone maintenance treatment (MMT) in China is poor.ObjectiveTo evaluate the effects of adjunctive contingency management (CM) on the efficacy of methadone maintenance treatment (MMT) in patients with opioid dependence.HypothesisA 12-week prize-based contingency management (CM) intervention can increase the retention and compliance of heroin abusers to standardized MMT programs in Shanghai.Methods160 heroin-dependent patients from three voluntary MMT clinics in Shanghai were randomly assigned to a treatment as usual group (MMT, n=80) and an intervention group (MMT+CM, n=80). Daily use of methadone was recorded and urine drug tests were conducted weekly during the first 12 weeks and then at week 16, week 20 and week 24.ResultsThe 12-week retention rates for the intervention (MMT+CM) and treatment-as-usual (MMT) groups were both quite high: 87.5% and 86.2%, respectively. The average durations of using methadone in the two groups were equal (70 days versus 71 days, respectively). There was a non-significant increase in the mean longest drug-free period (7.4 weeks versus 6.5 weeks) and in the mean number of negative urine tests (7.9 versus 7.6). Secondary analysis of the 24-week outcomes (12 weeks after termination of the adjunctive CM treatment) also found no significant differences between the groups. Among those who remained in the program the severity of addiction as assessed by the Addiction Severity Index decreased dramatically over the 24 weeks but, again, there were no significant differences in the addiction measures between those in the intervention group and those in the treatment-as-usual group.ConclusionPrize-based CM is not effective in improving the retention and compliance of heroin abusers to MMT in Shanghai. The main reasons for failure to replicate western studies were the unexpectedly high baseline rates of compliance in this sample (86%) and the relatively weak financial incentives provided by the CM program. CM programs are context dependent so a careful preliminary situational analysis is needed to determine their potential effectiveness at a particular site and to identify the types of incentives (prizes) that will effectively encourage behavioral change in the target participants.

Hepatitis C Knowledge and Alcohol Consumption among Patients Receiving Methadone Maintenance Treatment in Shanghai, China

Objective: The aim was to investigate hepatitis C virus (HCV) knowledge and alcohol consumption among patients (n = 114) in a methadone maintenance treatment (MMT) clinic in Shanghai. Methods: A cross-sectional survey was carried out in an MMT clinic. Structured questionnaires (HCV Knowledge Scale and Alcohol Use Disorders Identification Test (AUDIT)) and some open-ended questions were used to assess (i) HCV knowledge, (ii) HCV treatment received, (iii) awareness of HCV status, and (iv) alcohol consumption. Results: Findings revealed the HCV-positive rate was 57.0%. There were significant gaps in knowledge about HCV and HCV treatment received. The group mean score of HCV knowledge was 11.3 out of 20 (SD = 2.1) and the mean score on the AUDIT was 3.2 (SD = 5.4). Most participants (68.4%) reported not knowing their HCV status. Among HCV-positive participants, only 15.3% had received HCV antivirus treatment and 18.4% expressed a need for counseling about HCV infection. Conclusions: Considering the limited HCV knowledge and low level of HCV treatment received, effective HCV education and intervention strategies should be developed to target patients in China’s MMT clinics. Moreover, alcohol screening should also be part of the routine assessments within MMT programs. Scientific Significance: This study reveals the importance of HCV testing and education among drug users in MMT clinics.

The Investigation of HIV and HCV Infection and Risk Factors among Opiate Drug Users in Beijing, China

Objective: To explore the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) and the risk factors among opiate drug users in Beijing. Methods: The opiate drug users enrolled in methadone maintenance treatment clinics of Beijing from 30 November 2004 to 31 March 2008 were investigated. The blood samples were collected and tested for HIV and HCV infection and questionnaires were used for all subjects admitted. Results: Among 1211 eligible subjects, 12 HIV and 713 HCV-positive subjects were observed; the HIV and HCV prevalences were .99% and 58.88%, respectively. Young age, unemployment, injection drug use, and more frequent and longer drug use were the independent risk factors for HCV infection using the multiple logistic regression analysis. The younger drug users are more likely to be infected than the older ones, and the adjusted odds ratios (OR) of 18–30 and 30–40 versus 40–54 years were 1.81 (95% confidence interval (95% CI): 1.13–1.92) and 1.51 (95% CI: 1.08–2.10). The drug users who were unemployed (OR = 1.70, 95% CI: 1.23–2.37), with injection drug use (OR = 10.99, 95% CI: 7.26–16.65), with more frequent drug use (OR = 2.42, 95% CI: 1.31–2.46), and with longer heroin abuse history (OR = 8.06, 95% CI: 1.19–57.54) were more likely to be infected with HCV. Conclusions: The HCV infection was popular among opiate drug users in Beijing. The findings indicated the need for educating the users taking into account their low literacy levels and the necessity for job training and decreasing the injection drug use and the frequency of drug use administrated as the prevention and intervention methods for controlling the HIV/HCV infection in this population.

Economic evaluation of methadone maintenance treatment in HIV/AIDS control among injecting drug users in Dehong, China

The purpose of this study was to analyze the cost and cost-effectiveness of methadone maintenance treatment (MMT) program in Dehong prefecture, Yunnan province, China. The cost-effectiveness analysis used process data retrospectively collected from the MMT clinics in Dehong Prefecture, Yunnan Province, from July 2005 to December 2007, a 30-month period available at the time of the study. Alternative estimates of the number of HIV infections prevented were calculated using incidence rate from cohort studies and retrospective studies. Program costs were collected retrospectively following standard methods using an ingredients methodology. The cost for each participant treated in MMT clinics was about $9.1–16.7 per month and the intervention averted 8.4–87.2 HIV infections with a cost-effectiveness of US$ 2509.3–4609.3 per HIV infection averted. This research demonstrates that MMT is a cost-effective intervention for reducing HIV transmission among injecting drug users, but the coverage of MMT intervention should be matched with the designed volume of MMT clinics to make the best use of resources.

Concurrent heroin use among methadone maintenance clients in China

Background The study examined concurrent illicit heroin use among methadone maintenance clients in China and its association with clients' demographic characteristics, treatment experience, and personal social network. Methods Face-to-face surveys were conducted with 178 clients randomly recruited from six methadone maintenance treatment (MMT) clinics in Sichuan, China. Concurrent heroin use was measured based on self-report of heroin use during the past 30 days and a confirmatory urine morphine test. The participants' demographic characteristics and treatment factors were measured and examined. The drug use status of their family members and friends was also assessed. Results A total of 80 participants (44.9%) who either reported illicit heroin use in the past 30 days or had a positive urine test were defined as using heroin concurrently. Having drug-using friends was significantly associated with increased concurrent heroin use. Longer length of treatment (2 years or longer) was associated with increased concurrent heroin use. Among those who had both drug-using family members and friends, more women (71.4%) than men (50.0%) used heroin. For those who had no drug-using family members or friends, more men (34.8%) than women (20.8%) used heroin. Discussion Study findings indicate an urgent need to address concurrent illicit heroin use among MMT clients. Further examination of the influence of social networks on concurrent drug abuse behavior is encouraged. Results also highlight the importance of understanding gender differences in treatment seeking and behavioral changes, which is crucial to the development of gender-specific treatment strategies.

Low Risk for Hepatitis C Seroconversion in Methadone Maintenance Treatment

To study the risk factors for seroconversion to hepatitis C virus (HCV) infection since admission to methadone maintenance treatment (MMT) and to characterize the seronegative admitted group. All 657 patients admitted to our MMT clinic in Tel Aviv, Israel, between 1993 and 2008 were prospectively followed up. Those who were HCV negative (n = 271) with >1 HCV tests (n = 207) were included for seroconversion analyses. Proportions of ever drug injectors, benzodiazepine abuse, and former USSR immigrants were higher among HCV sera-positive versus sera-negative patients on admission to MMT. The incidence of HCV seroconversion in MMT was 2/100 person years [py] (25 seroconversions, 1133.9 py). Seroconversion rates were higher among 44 younger patients (<30 years: 9.6/100 vs 1.4/100 py, P < 0.0005), among 103 patients with positive urine results to benzodiazepines (3.6/100 vs 1/100 py, P = 0.005), among 118 patients who injected the drugs (3.9/100 vs 1/100 py, P = 0.003), and among 43 patients who dropped out and were readmitted to the MMT (4.3/100 vs 1.7/100 py, P = 0.04). There was a trend of higher seroconversion among 61 females (P = 0.1), among 62 patients with no children (P = 0.1), and among those having hepatitis B antigen (n = 7; P = 0.09). Variables that predicted seroconversion were drug injection, benzodiazepine abuse, and being younger at admission to MMT. Being a former USSR immigrant did not predict seroconversion. The HCV seroconversion rate of patients in MMT is low, also, for former USSR immigrants. The predictors for seroconversion were only admission variables (younger age at admission to MMT, ever drug injector, and having positive urine to benzodiazepines at MMT admission). Specific intervention to eliminate seroconversion is needed for these high-risk groups.

Longitudinal patterns of benzodiazepine consumption in a German cohort of methadone maintenance treatment patients

Cross-sectional studies show that considerable proportions of opiate dependents in methadone maintenance treatment (MMT) consume benzodiazepines (BZD). The longitudinal patterns of BZD use over time were described here. After admission to MMT, patients from two outpatient MMT clinics (n = 345) were observed for up to 2 years whilst in treatment. The use of BZD, cannabis, opiates and cocaine was assessed by urine sampling carried out twice a month. For the whole sample, the mean BZD-positive urine specimen rate was 0.36 during the first 3 months. Rates slightly decreased during the first year and remained stable afterwards (last observation carried forward). For study completers (n = 152), the rate decreased over time, from 0.31 (first 3-month period) to 0.19 (last period; p < 0.001). According to a longitudinal cluster analysis, 26% of all patients showed a pattern of constantly high BZD-positivity rates, mostly in combination with other substances. Inpatient detoxifications from BZD (carried out in 18% of cases) did not have a sustained effect on levels of BZD use. BZD consumption in MMT is often part of a polydrug consumption pattern and is associated with poorer treatment retention. It is necessary to further investigate the reasons for BZD use in MMT patients and to develop effective interventions to reduce levels of BZD consumption.

Effects of a randomized contingency management intervention on opiate abstinence and retention in methadone maintenance treatment in China.

Methadone maintenance treatment has been made available in China in response to the rapid spread of human immunodeficiency virus (HIV), but high rates of dropout and relapse are problematic. The aim of this study was to apply and test if a contingency management (or motivational incentives) intervention can improve treatment retention and reduce drug use. Random assignment to usual care with (n = 160) or without (n = 159) incentives during a 12-week trial. Incentives participants earned draws for a chance to win prizes on two separate tracks targeting opiate-negative urine sample or consecutive attendance; the number of draws increased with continuous abstinence or attendance. Community-based methadone maintenance clinics in Shanghai and Kunming. The sample was 23.8% female, mean age was 38, mean years of drug use was 9.4 and 57.8% had injected drugs in the past 30 days. Treatment retention and negative drug urine. Relative to the treatment-as-usual (control) group, better retention was observed among the incentive group in Kunming (75% versus 44%), but no difference was found in Shanghai (90% versus 86%). Submission of negative urine samples was more common among the incentive group than the usual care (74% versus 68% in Shanghai, 27% versus 18% in Kunming), as was the longest duration of sustained abstinence (7.7 weeks versus 6.5 in Shanghai, 2.5 versus 1.6 in Kunming). The average total prize amount was 371 Yuan (or $55) per participant (527 for Shanghai versus 216 in Kunming). Contingency management improves treatment retention and drug abstinence in methadone maintenance treatment clinics in China, although there can be considerable site differences in magnitude of effects.

Earning “Take-Home” Privileges and Long-Term Outcome in a Methadone Maintenance Treatment Program

This observational prospective study aimed to determine whether duration to the earning of privileges of "take-home" methadone doses (as a part of behavioral enforcement) reflects long-term outcome of patients in methadone maintenance treatment (MMT). All 657 former heroin addicts admitted to our MMT clinic between June 1993 and June 2008 were prospectively studied and followed up. Duration from admission to first take-home dose (until October 2008), to leaving (retention, until June 2009), and to dying (survival, until June 2008) was calculated. Most patients (n = 435; 66.2%) ever achieved take-home privileges. Retention was longest (10 years, 95% confidence interval [CI]: 8.8 to 11.2) for 110 patients who achieved their first take-home dose after 3 to 6 months, followed by 9 years (95% CI: 7.7 to 10.3) for 98 patients who achieved it after >6 months and ≤1 year, and 8.3 years (95% CI: 7.2 to 9.4) for 127 patients who managed to achieve it only after >1 year. Retention was lower among patients who were given exceptional take-home doses (not respecting policy regulations) <3 months since admission: 5.1 years (95% CI: 3.4 to 7.8) for 30 patients (who got it for medical reasons), 9 years (95% CI: 6.7 to 11.3) for 14 patients admitted from another MMT, and 6.3 years (95% CI: 5 to 7.6) for 56 patients who got it for unjustified (mistakes) reasons. The shortest retention in MMT was 2.2 years (95% CI: 1.8 to 2.7, P < 0.0005) for 222 patients who never managed to achieve any take-home privileges. Survival was longer among patients who ever versus never received take-home privileges (13.2 years [95% CI: 12.8 to 13.6] vs 12.3 years [95% CI: 11.5 to 13.1], respectively; P = 0.04) and longest (14.1 years [95% CI: 13.4 to 14.7]) among those who received take-home privileges after 3 to 6 months. The group with the shortest time (3 to 6 months) to the achievement of first take-home dose had the best outcome. Further studies are needed to characterize this group.

Patterns of attendance in methadone maintenance treatment program in Yunnan Province, China

Objective: To describe the patterns of patients' attendance over the first three quarters of a year under methadone maintenance treatment (MMT) clinics in Yunnan Province, China. Methods: Data were obtained from drug abuse treatment databases from five MMT clinics in Yunnan Province. Patients registered between April 2007 and December 2007 were included in the analysis. The study period was divided into three phases consisting of 3 months each. Logistic regression was used to predict factors determining whether the patients attended the clinic on each day with repetition of the patients taken into account. Results: The median number of days attending the clinics was 61 in the total treatment period, and the likelihood of a patient attending the clinic in the second and third phases was significantly less [odds ratio (OR) = .44 and .30, 95% confidence interval (CI) = .40–.49 and .26–.34] compared with the first phase. The predictors for attendance at clinic were being unmarried (OR = .63, 95% CI = .49–.82), self-employed (OR = .18, 95% CI = .11–.28), having a history of syringe sharing (OR = .67, 95% CI = .48–.92), and having been in a detoxification program (OR = 1.59, 95% CI = 1.09–2.33). Conclusion: Heroin users attended MMT programs irregularly and their periods of attendance significantly declined by duration of the time they stayed in the treatment program. Additional interventions should be employed to help patients adhere to this long-term treatment program.

Multiple substance use among heroin-dependent patients before and during attendance at methadone maintenance treatment program, Yunnan, China

BackgroundMultiple substance use is a common problem among heroin users. This study aims to describe patterns of multiple substance use one year before and during attendance at methadone maintenance treatment (MMT) programs and associated variables of continued heroin use in MMT clinics in Yunnan, China. MethodsThe study was conducted among 168 heroin addicts who had received treatment for at least one year at two MMT clinics in Kunming city. A structured questionnaire, a medical record, and computer database were used to obtain history of substances use, significant clinical information, and treatment details, respectively. ResultsHeroin, tobacco, and alcohol were the most commonly used substances both before and during MMT. After one year in MMT, use of heroin, alcohol, tramadol, and triazolam significantly decreased whereas use of ephedrine increased. Simultaneous substance use was halved but the decrease was not statistically significant. The proportion of injecting users was reduced from 61% to 43%. History of heroin use in the preceding 6 months during MMT increased the odds of continued heroin use (OR=5.8, 95% CI=[2.9–11.3]). An average 10mg higher methadone dose increment was associated with a reduced odds of heroin use by 10%. ConclusionMMT did not reduce the number of substances used, but the number of injecting heroin users after the first year of treatment decreased. Heroin use in the preceding 6 months during MMT treatment and lower methadone dose were associated with continued heroin use in MMT.

Behavioral drug and HIV risk reduction counseling (BDRC) in MMT programs in Wuhan, China: A pilot randomized clinical trial

This pilot clinical trial evaluated whether the efficacy of methadone maintenance treatment (MMT) provided with limited psychosocial services is improved by the addition of manual-guided behavioral drug and HIV risk reduction counseling (BDRC). Heroin dependent individuals ( n = 37) enrolling in two MMT clinics in Wuhan, China, received standard MMT services, consisting of daily medication at the clinics and infrequent additional services on demand, and were randomly assigned to MMT only ( n = 17) or MMT with weekly individual BDRC ( n = 20) for 3 months. Participants were followed for six months from the time of enrollment (3 months active counseling phase and 3 months follow-up while treated with standard MMT). Primary outcome measures included reductions of HIV risk behaviors and illicit opiate use and treatment retention. Participants were 81% male; mean (SD) age 36.7 (7.2) years; there were no significant baseline differences between the two groups. Participants in MMT + BDRC achieved both greater reductions of HIV risk behaviors ( p < 0.01), as indicated by the scores on a short version of the AIDS Risk Inventory, and of illicit opiate use, as indicated by the proportions of opiate negative test results during the active phase of the study and the follow-up ( p < 0.001). 83.3% in the MMT + BDRC group and 76.2% in the standard MMT group were still actively participating in MMT at 6 months. Manual-guided behavioral drug and HIV risk reduction counseling is feasible to deliver by the trained MMT nursing personnel and appears to be a promising approach for improving the efficacy of standard MMT services in China.

New Community-Based Methadone Maintenance Treatment Programs in Guangdong, China, and Their Impact on Patient Quality of Life

A cohort of 516 patients at two community-based methadone maintenance treatment (MMT) clinics in Guangdong province, China, was interviewed at initiation of treatment and at 1, 3, and 6 months of follow-up to collect demographic information, drug use experience, social support, and changes of quality of life (QOL) over treatment. Covariance analysis and generalized estimation equation model were used to compare the QOL scores over time and to identify factors possibly influencing QOL scores. The results suggested that MMT is effective at improving QOL scores in physical, psychological, and social domains. Being currently employed, having good family relationships, job as the source of income, and particularly a longer time in treatment were significantly associated with QOL improvements in at least one domain. The study's limitations are noted.