Impact of a methadone maintenance program on an Aboriginal community: a qualitative study

Abstract: Background: Methadone maintenance treatment programs implemented in Aboriginal communities have proven to be beneficial for the control of opioid addiction and its associated consequences, but the perceptions and opinions of different community members about these programs remain elusive. The goal of this study was to determine the perceptions of members of a First Nation community in New Brunswick, Canada, on the implementation of a methadone maintenance treatment program and its effects on the community. Methods: We conducted a qualitative study using semistructured focus group discussions with 3 distinct groups composed of health care professionals and influential community members, patients in the methadone maintenance treatment program and community members at large. Thematic analysis of discussion transcripts was performed. Results: A total of 22 partipants were included in the 3 focus groups. All groups of participants expressed that patients in the program are stigmatized and marginalized. Discussions also revealed widespread misconceptions about the program. Participants associated the program with improvements in community-level outcomes and in parenting abilities of patients, but also with difficulties preserving family unity. Interpretation: Despite being culturally adapted to the community, elements surrounding the methadone maintenance treatment program in this First Nation community appear to be misunderstood and stigmatized. It may be beneficial to provide community education on these programs to assure community buy-in for the successful implementation of harm reduction programs in Aboriginal communities

Service providers' adherence to methadone maintenance treatment protocol in China.

BACKGROUND:Methadone maintenance treatment (MMT) programs have expanded rapidly in China during the last decade. However, variance in service providers' practice may have an impact on the quality of care received by the patients. This study examined Chinese service providers' adherence to the MMT protocol and its associated factors. METHODS:The study used baseline data from a randomized intervention trial implemented in MMT clinics in five provinces of China. The data were collected from January 2012 to August 2013. A total of 418 service providers from 68 MMT clinics participated in the study. Demographic and job-related characteristics were collected. The providers' adherence to the MMT protocol, MMT knowledge, negative attitudes towards people who use drugs (PWUD), and perceived institutional support were assessed. RESULTS:The average adherence score was 36.7 ± 4.3 (out of 9-45). Fewer providers adhered to the protocol items where communications with patients or families were required. After controlling for potential confounders, adherence to the MMT protocol was positively associated with perceived institutional support (standardized β = 0.130; p = 0.0052), and negatively associated with prejudicial attitudes towards PWUD (standardized β = -0.357; p < 0.0001). Reception of national-level MMT training was not associated with higher level of adherence to protocol. CONCLUSION:The findings suggest the potential benefits of providing institutional support to MMT providers to enhance their level of adherence to the MMT protocol. Intervention effort is needed to reduce negative attitudes towards PWUD among MMT service providers to achieve greater consistency with best-practice recommendations

Methadone Maintenance Treatment Decentralization in Vietnam

BackgroundTo respond to the dual HIV and injecting drug use epidemic, Vietnam has implemented methadone maintenance treatment (MMT) nationwide since 2010 and decentralized it to primary care (i.e. commune health centers) since 2015. The study aims to explore the challenges that Vietnamese community health workers (CHW) at commune health centers encounter in providing MMT and the factors associated to these challenges.MethodsThis study had a mixed method design. We used two types of data in this study. For the sub-study 1, we used the secondary data from a quantitative survey conducted in Vinh Phuc and Phu Tho provinces among 300 CHWs who did not provide MMT at the time of the study. For the sub-studies 2 and 3, we collected quantitative and qualitative primary data from Dien Bien province. We conducted a quantitative survey among 276 CHWs including both MMT providers and non-MMT providers. From this sample, we selected 26 MMT providers with various characteristics for in-depth interviews.ResultsIn the sub-study 1, the mean score of CHWs’ interaction with PWUD 36.4 (SD 8.8) on a scale of 60. The interaction between CHW not providing MMT and people who use drugs (PWUD) was negatively associated with their stigmatizing attitude towards PWUD (β = -0.84, 95% CL: -1.05; -0.63) after adjusting for their background (gender, education level, job position and years of working experience) and job-related characteristics (perceived risk and challenges when working with PWUD, job satisfaction and empathy towards PWUD). In the sub-study 2, 114 (41.3%) CHW had ever provided MMT services. Better MMT knowledge was associated with higher levels of confidence in providing MMT services among CHW who had no experience with MMT program (β=0.90, 95%CL: 0.29; 1.51), not among those who had experiences. On the other hand, technical support in working with PWUD was associated with a higher level of confidence in providing MMT services for both groups (β=0.71, 95%CL: 0.35; 1.08 and β=0.58, 95%CL: 0.19; 0.96 among CHWs who had ever and who had never worked in MMT, respectively). In sub-study 3, the perceived challenges for MMT provision included lack of confidence and motivation to provide MMT, inadequate human resource, lack of institutional support, insufficient technical support, lack of referral resources and additional support for patients, lack of policies to support the MMT program at CHCs and to protect service providers.ConclusionCHWs in Vietnam faced several challenges in working with PWUD and providing MMT services at primary care settings. Supportive policies and tailored interventions should be developed at different levels to ensure the quality and effectiveness of the MMT decentralization program

Wie effektiv sind Methadonbehandlungen in Privatpraxen∋

Summary: Objectives:Involvement of private practitioners in methadone maintenance treatment (MMT) enhances its availability. However, effectiveness of such treatments is still debated. Methods:A retrospective case register analysis comparing the retention of private practices with that of specialised institutions. All methadone maintenance treatment starting between January 1, 1997 and December 31, 1999. Kaplan-Meier survival estimates to test for different retention times; Cox-regression procedure to control for baseline differences between the two populations. Results:Even after controlling for distinct patient characteristics, MMT by private practitioners resulted in a longer retention time. Conclusions:Our findings favour the involvement of private practitioners. Providing better professional and financial support may enhance their participatio

An intervention trial targeting methadone maintenance treatment providers to improve clients' treatment retention in China.

BackgroundService providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention.MethodsThis study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period.ResultsSignificantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90).ConclusionsThe MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs

Family Related Factors and Concurrent Heroin Use in Methadone Maintenance Treatment in China.

BackgroundThe use of heroin during Methadone Maintenance Treatment (MMT) is a challenging problem that contributes to poor treatment outcomes. Families may play an important role in addressing concurrent heroin use during MMT, especially in collectivist societies such as China.ObjectivesIn this study, we explored the relationship between family-related factors and concurrent heroin use during MMT in China.MethodsThis study was conducted at 68 MMT clinics in five provinces of China. There were 2,446 MMT clients in the analysis. Demographic information, MMT dosage, family members' heroin use status, family support of MMT, family problem, and self-reported heroin use were collected in a cross-sectional survey. The most recent urinalysis of opiate use was obtained from clinical records.ResultsOf the 2,446 participants, 533 (21.79%) self-reported heroin use in the previous seven days or had a positive urine morphine test result in the clinic record. Participants whose family member[s] used heroin were 1.59 times (95% CI: 1.17, 2.15) more likely to use concurrently during treatment. Those with family members who totally support them on the MMT were less likely to use (AOR: 0.75, 95% CI: 0.60, 0.94). Having more family problems was positively associated with concurrent heroin use (AOR: 2.01, 95% CI: 1.03, 3.93).ConclusionsThe results highlight the importance of the family's role in concurrent heroin use during MMT programs. The study's findings may have implications for family-based interventions that address concurrent heroin use

Impact of Physical Activity on Stress Levels and Methadone Maintenance Treatment Outcomes

Introduction: While the opioid epidemic has continued to intensify over the last decade, unfortunately the likelihood of achieving stable long-term abstinence using methadone maintenance treatment (MMT) remains as low as 60 percent. Perceived stress has been identified as a factor predictive of premature termination and relapse, making stress reduction an important area of study in MMT. However, little research is available on the effects of active stress-coping mechanisms on MMT outcomes. Objective: To address this gap, the current study was conducted to examine the impact of physical activity on stress reduction and treatment outcomes. Methods: This was a retrospective cohort study in which ninety-three consecutive admissions to a university sponsored, community-based, outpatient medication-assisted treatment facility in Pennsylvania were reviewed. The 46 individuals (49.5%) who remained active in treatment at 6 months post-admission represented the study sample. Thirty-four of these individuals completed an initial assessment with the 4-item Perceived Stress Scale (PSS4) allowing investigators to determine stress levels at admission. The 27 individuals scoring above the 25th percentile were categorized as “high stress” and retained for further interviewing. Of these 27 individuals, 22 completed both the 10-item Perceived Stress Scale (PSS10) to assess stress levels at approximately 6 months post-admission as well the Global Physical Activity Questionnaire (GPAQ), which measured physical activity levels at admission and 6 months post-admission. Results: The mean age at time of study was 40. 52± 11.84 years; 68% of study participants were male, 65% were Caucasian, 79% were unemployed, and 91% were unmarried. In the first 180 days of treatment, subjects were dosed on average of 164.02 days (91. 1%) with the average dose equaling 85. 40± 40.2 milligrams per day. Consistent with prior research, results indicated that stress levels dropped significantly from admission to 6 months post-entry from a mean stress level of 2. 82±.59 to 1.88±. 80, t(22)=4. 971, p Conclusion: Our data, based on a limited sample, suggests that treatment is associated with decreased levels of stress levels in this population. Interestingly, patients attributed their decreased physical activity levels to reduced or nonexistent drug-seeking activity, as well as to the demanding time-commitment of MMT. Our failure to find significant effects of exercise may be a consequence of sampling procedures and sample size. To better address this question, future controlled studies might focus on incorporating physical exercise in MMT treatment to determine if those who regularly engage in physical activity demonstrate better outcomes in MMT. Identification of positive effects will allow the medical community to introduce non-pharmaceutical approaches to the treatment of opioid use disorders

The SUMMIT trial: a field comparison of buprenorphine versus methadone maintenance treatment.

This prospective patient-preference study examined the effectiveness in practice of methadone versus buprenorphine maintenance treatment and the beliefs of subjects regarding these drugs. A total of 361 opiate-dependent individuals (89% of those eligible, presenting for treatment over 2 years at a drug service in England) received rapid titration then flexible dosing with methadone or buprenorphine; 227 patients chose methadone (63%) and 134 buprenorphine (37%). Participants choosing methadone had more severe substance abuse and psychiatric and physical problems but were more likely to remain in treatment. Survival analysis indicated those prescribed methadone were over twice as likely to be retained (hazard ratio for retention was 2.08 and 95% confidence interval [CI] = 1.49-2.94 for methadone vs. buprenorphine), However, those retained on buprenorphine were more likely to suppress illicit opiate use (odds ratio = 2.136, 95% CI = 1.509-3.027, p < .001) and achieve detoxification. Buprenorphine may also recruit more individuals to treatment because 28% of those choosing buprenorphine (10% of the total sample) stated they would not have accessed treatment with methadone

Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting

CONTEXT Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients. OBJECTIVE To characterize the feasibility of OBOT-B in homeless relative to housed patients. DESIGN A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior. RESULTS Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P=.94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5–1.7) P=.8], utilization of counseling (homeless, 46%; housed, 49%; P=.95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P=.96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients. CONCLUSIONS Despite homeless opioid dependent patients' social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment