Structural-level factors affecting implementation of the methadone maintenance therapy program in China

Department of Epidemiology, School of Public Health, University of California at Los Angeles, Los Angeles, CA 90024, USA.
Journal of substance abuse treatment (Impact Factor: 2.9). 12/2009; 38(2):119-27. DOI: 10.1016/j.jsat.2009.09.002
Source: PubMed


This study identifies structural-level factors influencing methadone maintenance therapy (MMT) program implementation in China. Twenty-eight service providers and 560 randomly selected clients from 28 MMT clinics in the study area underwent face-to-face interviews. Number of clients, retention rate, coverage, and structural-level factors were collected from a survey of service providers. Individual-level factors and self-reported illicit drug use information were obtained from clients. Urine specimens were collected from the client participants to test for heroin use. Clinics affiliated with the local Centers for Disease Control and Prevention (CDC) had more clients, higher retention rates, and broader coverage than those not affiliated with the CDC. Longer operating hours, incentive for compliant clients, and comprehensive services were positively associated with client recruitment and coverage. Comprehensive services and incentives for compliant clients were negatively associated with concurrent illicit drug use. Comprehensive services should be incorporated into the MMT program. Extended operating hours and incentives for compliant clients should be implemented.

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Available from: Chunqing Lin, May 08, 2014
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    • "The current study used registration data from MMT clinics as no data from a specific survey of drop-outs were available. According to existing research on MMT in China, the reasons for dropping out of MMT—in addition to demographic factors such as gender, education level, and age—mainly include frequent contact with drug abusers, crime, being remanded in custody for drug abuse, and going to work in another city [28-31]. Based on our examinations of the existing research and the practice of MMT in Hubei Province, we think the reasons for client dropout may be related to social issues the clients encounter, not physiological or biological issues. "
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    ABSTRACT: To view methadone maintenance treatment (MMT) globally, it is necessary to accumulate data on MMT policy implementation under different health service systems. The aim of the current study is to provide empirical evidence about policy implementation of MMT and HIV infection control, as well as recommendations for improvement of MMT in the future. Based on China's national policy framework of MMT, policy implementation of MMT in Hubei province has two objectives: 1) to create linkages between health and public security, and 2) to provide integrated services for management of drug abusers. From 2007 to 2011, following the establishment of MMT clinics that provide methadone as well as HIV prevention services, the proportion of HIV infection among drug abusers decreased relatively quickly (12.12% [rightwards arrow] 5.77% [rightwards arrow] 5.19% [rightwards arrow] 2.39% [rightwards arrow] 2.04%). However, high drop-out rate and poor information management have been identified as particular problems which now need to be addressed. Furthermore, client drop-out from MMT programs may reflect social issues the clients encounter, and consequently, sustainable MMT development requires incorporation of social measures that help MMT clients return to society without discrimination, especially through family cooperation and employment opportunities.
    Substance Abuse Treatment Prevention and Policy 11/2013; 8(1):38. DOI:10.1186/1747-597X-8-38 · 1.16 Impact Factor
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    • "It takes an extended period of time and staff experience to provide the understanding and willingness to treat with high doses of medication. This was also concluded by Lin et al. (2010) in their study evaluating 28 MMT clinic outcomes, where it was found that clinics with Centers for Disease Control and Prevention (CDCP) involvement, as well as higher methadone doses, achieved better retention, suggesting a possible correlation between these two variables. We note that relatively high methadone doses were administered at this clinic, in contrast with most clinics throughout China (Wang et al. 2007; Chen et al. 2009; Liang et al. 2009; Hao et al. 2007). "
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    ABSTRACT: The initiation of the first methadone maintenance treatment program (MMT) in Macao was founded in collaboration between MMT clinics in the USA and Israel. All patients admitted into treatment between October 2005 and October 2008 were prospectively followed through March 2010. Of the 163 patients, 81% were male, the mean age on admission was 39.5 (sd = 10.2). Seventy-three percent (n = 119) were hepatitis C sera positive, and 4.9% (n = 8) were HIV sera positive. One-year treatment retention rate was 59.5%, with 52.6% of the 95 patients who stayed in treatment having an opiate-negative urine test at the 10-month evaluation. Four and a half years of follow-up showed mean long-term retention (Kaplan Meier analyses) of 2.2 years. Higher methadone dose (> or = 80 mg/day) and hepatitis C sera positive status were predictors for longer treatment retention. This study describes an effective model of MMT that supports the expansion of addiction treatment in other countries.
    Journal of psychoactive drugs 09/2013; 45(4):313-21. DOI:10.1080/02791072.2013.825032 · 1.10 Impact Factor
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    • "A higher dose of methadone was reported by most previous studies to be associated with less illicit opiate abuse and longer retention in treatment (Amato et al., 2005; Kamal et al., 2007; Strain et al., 1999). Appropriate psychological counseling and comprehensive services were also correlated with lower rates of drug use (Joe & Simpson, 2001; Lin et al., 2010). Ilgen, Jain, Kim, and Trafton (2008) found that MMT patients with high stress levels may be particularly vulnerable to heroin relapse. "
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    ABSTRACT: 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. 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. 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. 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.
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