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Janssen E, Vuolo M, Spilka S, Airagnes G. Predictors of concurrent heroin use among patients on opioid maintenance treatment in France: a multilevel study over 11 years. Harm Reduct J 2024; 21:15. [PMID: 38243253 PMCID: PMC10799399 DOI: 10.1186/s12954-024-00934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Consistent reports from health professionals suggest that heroin is commonly used by patients undergoing opioid maintenance treatment (OMT) in France, potentially jeopardizing their recovery process. However, there has been no formal epidemiological assessment on the matter. METHODS We use a yearly updated compendium retrieving information on patients admitted in treatment centres in France between 2010 and 2020. Given the hierarchical nature of the data collection, we conduct 2-level modified Poisson regressions to estimate the risks of past month heroin use among patients on OMT. RESULTS Despite an overall decreasing trend over time, heroin use among patients on OMT is indeed common, with half of patients declaring concurrent use. Our study unveils differentiated risks of heroin use vary according to the type of OMT, with patients on methadone more likely to use heroin compared to those on buprenorphine. The use of multilevel-related measures also uncovers high heterogeneity among patients' profiles, reflecting different stages in the treatment process, as well as differentiated practices across treatment centres. CONCLUSION Opioid maintenance treatment is associated with heroin use, in particular when methadone is involved. The heterogeneity among patients on OMT should be given particular attention, as it underscores the need for tailored interventions.
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Affiliation(s)
- Eric Janssen
- French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), 69 rue de Varenne, 75007, Paris, France.
| | - Mike Vuolo
- Department of Sociology, Ohio State University, 238 Townhsend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
| | - Stanislas Spilka
- French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), 69 rue de Varenne, 75007, Paris, France
- General Population Surveys Unit, Research Centre on Population Epidemiology and Health (Centre de Recherche en Epidémiologie et Santé des Populations-CESP), Unit 1018, INSERM, Villejuif, France
| | - Guillaume Airagnes
- French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), 69 rue de Varenne, 75007, Paris, France
- UFR de Médecine, Faculté de Santé, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015, Paris, France
- Population-Based Cohorts Unit, UMS 011, INSERM, 16 avenue Paul Vaillant-Couturier, 94800, Villejuif, France
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Nguyen HTT, Dinh DX. Opioid relapse and its predictors among methadone maintenance patients: a multicenter, cross-sectional study in Vietnam. Harm Reduct J 2023; 20:136. [PMID: 37717002 PMCID: PMC10505306 DOI: 10.1186/s12954-023-00872-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/14/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Opioid relapse, one of the common and severe problems during methadone maintenance treatment, can give rise to poor treatment outcomes. This study measured the opioid relapse rate and its associated factors among methadone maintenance patients in Vietnam. METHODS Information about the demographic characteristics and social support of 655 patients was collected through direct interviews. Medical records were used to gather data on treatment characteristics. Relapse was determined via urine opioid test results. RESULTS The overall relapse rate of patients during treatment was 13.1%. According to the multivariate logistic regression model, living in mountainous areas (adjusted odds ratio (aOR) = 3.63, 95% CI 1.90-7.46) and long duration of drug use in the past (aOR = 1.06, 95% CI 1.03-1.09) were associated with an increase in the odds of opioid relapse. By contrast, living with many family members (aOR = 0.69, 95% CI 0.55-0.85), having longer treatment time (aOR = 0.80, 95% CI 0.73-0.87), and completely adhering to treatment (aOR = 0.38, 95% CI 0.23-0.64) were protective for opioid relapse. As per the univariate analyses, the odds of opioid relapse declined by 25% for each increase of one close friend or relative (OR = 0.75, 95% CI 0.66-0.86). Regarding social support (range score: 0-100), each additional increase of one score was associated with a 1% decrease in the odds of opioid relapse (OR = 0.99, 95% CI 0.98-0.99). Patient sex, education level, occupation type, patient's monthly income, family's monthly income, the number of previous treatments, daily methadone dose, comorbidity, and received antiretroviral therapy were not associated with opioid relapse among patients (p > 0.05). CONCLUSIONS Residence, the role of family and social support, and treatment adherence should be paid more attention to guarantee and enhance the success of methadone maintenance treatment.
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Affiliation(s)
- Huong Thi Thanh Nguyen
- Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi City, 111000, Vietnam
| | - Dai Xuan Dinh
- Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi City, 111000, Vietnam.
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Nong T, Hodgkin D, Trang NT, Shoptaw SJ, Li MJ, Hai Van HT, Le G. A review of factors associated with methadone maintenance treatment adherence and retention in Vietnam. Drug Alcohol Depend 2023; 243:109699. [PMID: 36603363 PMCID: PMC9851667 DOI: 10.1016/j.drugalcdep.2022.109699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Starting in 2008, Vietnam's national MMT program expanded quickly, but it is struggling with increasing attrition rates and poor adherence among patients. Several studies have reported on MMT retention and adherence, but no overview has yet been published. The objective of this study is to fill that gap and to review factors associated with retention and adherence in MMT in Vietnam. METHODS A systematic search was conducted using databases of literature - Pubmed, Cochrane, Scopus, Academic search premiere, and SoINDEX. Peer-reviewed empirical studies with full text in English discussing retention attrition and adherence regarding MMT in Vietnam were selected. The results were synthesized using qualitative methods. RESULTS Adherence and retention rates varied among the 11 included studies. In general, patients in mountainous provinces had lower adherence and retention rates than those in big cities. Retention rates decreased with the studies' follow-up period and had a downward trend over time. Factors associated with adherence and retention can be classified into three groups: individual, community, and institutional factors. Important individual factors areage, education, awareness of MMT and HIV, and co-occurring disorders and comorbidities. Stigma is the major community risk factor, and methadone daily dose, the distance between home and clinic, and clinic's service hours are the three most important institutional factors. CONCLUSIONS The literature reviewed identifies important factors associated with MMT adherence and retention in Vietnam. The findings suggest further research exploring both subjective and objective factors and more policies to remove social and structural barriers to enhance treatment outcomes.
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Affiliation(s)
- Thuong Nong
- The Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA 02453, the United States of America.
| | - Dominic Hodgkin
- The Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA 02453, the United States of America
| | - Nguyen Thu Trang
- Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Viet Nam
| | - Steven J Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, the United States of America
| | - Michael J Li
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, the United States of America
| | | | - Giang Le
- Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Viet Nam
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Tran T, Rigg KK. Substance use among methadone patients in Vietnam: a systematic review. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2022.2162989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Tram Tran
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, USA
| | - Khary K. Rigg
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, USA
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Button D, Cook R, King C, Khuyen TT, Kunkel L, Bart G, Thuy DT, Nguyen DB, Blazes CK, Giang LM, Korthuis PT. Correlates of days of medication for opioid use disorder exposure among people living with HIV in Northern Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103503. [PMID: 34768124 PMCID: PMC8810676 DOI: 10.1016/j.drugpo.2021.103503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In Vietnam, access to medications for opioid use disorder (MOUD) for people living with HIV has rapidly expanded, but MOUD use over time remains low. We sought to assess factors associated with days of MOUD treatment exposure. METHODS From 2015 to 2019, patients with OUD in six Northern Vietnamese HIV clinics were randomized to receive HIV clinic-based buprenorphine (BUP/NX) or referral for methadone maintenance therapy (MMT) and followed for 12 months. All MOUD doses were directly observed and abstracted from dosing logs. The primary outcome was days of MOUD treatment exposure (buprenorphine or methadone) received over 12 months. Negative binomial regression modelled associations with days of MOUD exposure. RESULTS Of 281 participants, 264 (94%) were eligible for analysis. Participants were primarily male (97%), unmarried (61%), employed (54%), and previously arrested (83%). Participants had a mean 187 (SD 150) days of MOUD exposure with 134 (51%) having at least 180 days, and 35 (13.2%) having at least 360 days of MOUD exposure. Age (IRR 1.26, 95% CI 1.02-1.55), income (IRR 0.96, 95% CI 0.93-1.001), and methadone (IRR 1.88, 95% CI 1.51-2.42) were associated with MOUD exposure in multivariate models. Multivariate models predicted 127 (95% CL 109-147) days of MOUD exposure for HIV clinic based-buprenorphine vs 243 (95% CL 205-288) for MMT. CONCLUSION MOUD treatment exposure was suboptimal among patients with HIV and OUD in Northern Vietnam and was influenced by several factors. Interventions to support populations at risk of lower MOUD exposure as well programs administering MOUD should be considered in countries seeking to expand access to MOUD.
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Affiliation(s)
- Dana Button
- MD/MCR Program, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Ryan Cook
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Caroline King
- MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Lynn Kunkel
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Gavin Bart
- Hennepin Healthcare, Minneapolis, MN, USA
| | | | | | | | | | - P Todd Korthuis
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
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Giang LM, Li MJ, Okafor CN, Diep NB, Shoptaw SJ. Correlates of methamphetamine use severity among patients receiving methadone maintenance treatment for opioid use disorder in Vietnam. J Subst Abuse Treat 2022; 132:108461. [PMID: 34098204 PMCID: PMC8572314 DOI: 10.1016/j.jsat.2021.108461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/16/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess the severity of methamphetamine use among methadone maintenance treatment (MMT) patients in Vietnam with opioid use disorder and concurrent methamphetamine use, and to identify risk factors associated with higher severity of methamphetamine use. METHODS We used survey data and medical record abstractions from 428 people with opioid use disorder who also use methamphetamine while partaking in methadone treatment in five clinics in Hanoi, Vietnam. We used multinomial logistic regression to assess other risk factors and problems associated with high methamphetamine use severity. RESULTS Those who reported injecting heroin in the past 3 months (AOR = 4.05, 95% CI [1.30, 12.55], p = 0.02), having a longer history of lifetime heroin use (AOR = 1.13, 95% CI [1.03, 1.24], p < 0.01), and having higher cravings (AOR = 1.97, 95% CI [1.31, 2.98], p < 0.01) and fatigue (AOR = 1.25, 95% CI [0.96, 1.61], p = 0.09) related to methamphetamine withdrawal had greater odds of high methamphetamine use severity. One of five clinics had a significantly higher percentage of methamphetamine use severity than others. CONCLUSION Successful MMT in patients with opioid use disorder in Vietnam may additionally require methamphetamine-focused screening and intervention.
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Affiliation(s)
- Le Minh Giang
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Michael J. Li
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles
| | - Chukwuemeka N. Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco Texas
| | - Nguyen Bich Diep
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Steven J. Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles
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Brown PCM, Thuy DTT, Edsall A, Hang NT, Mai PP, Hoffman K, Bart G, Korthuis PT, Giang LM. Familial support in integrated treatment with antiretroviral therapy and medications for opioid use disorder in Vietnam: A qualitative study. Subst Abus 2022; 43:1004-1010. [PMID: 35435799 PMCID: PMC9678077 DOI: 10.1080/08897077.2022.2060435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Patients report that familial support can facilitate initiation and maintenance of antiretroviral therapy (ART) and medications for opioid use disorder (MOUD). However, providing such support can create pressure and additional burdens for families of people with opioid use disorder (OUD) and HIV. We examined perspectives of people with HIV receiving treatment for OUD in Vietnam and their family members. Methods: Between 2015 and 2018, we conducted face-to-face qualitative interviews with 44 patients and 30 of their family members in Hanoi, Vietnam. Participants were people living with HIV and OUD enrolled in the BRAVO study comparing HIV clinic-based buprenorphine with referral to methadone treatment at 4 HIV clinics and their immediate family members (spouses or parents). Interviews were professionally transcribed, coded in Vietnamese, and analyzed using a semantic, inductive approach to qualitative thematic analysis. Results: Family members of people with OUD and HIV in Vietnam reported financially and emotionally supporting MOUD initiation and maintenance as well as actively participating in treatment. Family members described the burdens of supporting patients during opioid use, including financial costs and secondary stigma. Conclusions: Describing the role of family support in the lives of people living with OUD and HIV in the context of Vietnam enriches our understanding of their experiences and will support future treatment efforts targeting the family unit.
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Affiliation(s)
| | | | - Andrew Edsall
- Oregon Health & Science University School of Medicine
| | | | | | - Kim Hoffman
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR
| | - Gavin Bart
- University of Minnesota Medical School and Hennepin Healthcare
| | - P. Todd Korthuis
- Oregon Health & Science University School of Medicine,Portland State University-Oregon Health & Science University School of Public Health, Portland, OR
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Ng SY, Chong JH, Mohd Mazlan MI, Lau BT. Illicit substance use among methadone maintenance therapy patients in a tertiary hospital in Malaysia: a cross-sectional study. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2018733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Siew Yen Ng
- Department of Pharmacy, Hospital Tuanku Ja’afar Seremban, Ministry of Health Malaysia, Seremban, Malaysia
| | - Jian Hui Chong
- Department of Pharmacy, Hospital Tuanku Ja’afar Seremban, Ministry of Health Malaysia, Seremban, Malaysia
| | - Mohamad Ikhwan Mohd Mazlan
- Department of Pharmacy, Hospital Tuanku Ja’afar Seremban, Ministry of Health Malaysia, Seremban, Malaysia
| | - Boon-Tiang Lau
- Department of Pharmacy, Hospital Port Dickson, Ministry of Health Malaysia, Port Dickson, Malaysia
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Frost MC, Lampert H, Tsui JI, Iles-Shih MD, Williams EC. The impact of methamphetamine/amphetamine use on receipt and outcomes of medications for opioid use disorder: a systematic review. Addict Sci Clin Pract 2021; 16:62. [PMID: 34635170 PMCID: PMC8504567 DOI: 10.1186/s13722-021-00266-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/10/2021] [Indexed: 01/01/2023] Open
Abstract
Background Methamphetamine/amphetamine use has sharply increased among people with opioid use disorder (OUD). It is therefore important to understand whether and how use of these substances may impact receipt of, and outcomes associated with, medications for OUD (MOUD). This systematic review identified studies that examined associations between methamphetamine/amphetamine use or use disorder and 3 classes of outcomes: (1) receipt of MOUD, (2) retention in MOUD, and (3) opioid abstinence during MOUD. Methods We searched 3 databases (PubMed/MEDLINE, PsycINFO, CINAHL Complete) from 1/1/2000 to 7/28/2020 using key words and subject headings, and hand-searched reference lists of included articles. English-language studies of people with documented OUD/opioid use that reported a quantitative association between methamphetamine/amphetamine use or use disorder and an outcome of interest were included. Study data were extracted using a standardized template, and risk of bias was assessed for each study. Screening, inclusion, data extraction and bias assessment were conducted independently by 2 authors. Study characteristics and findings were summarized for each class of outcomes. Results Thirty-nine studies met inclusion criteria. Studies generally found that methamphetamine/amphetamine use or use disorder was negatively associated with receiving methadone and buprenorphine; 2 studies suggested positive associations with receiving naltrexone. Studies generally found negative associations with retention; most studies finding no association had small samples, and these studies tended to examine shorter retention timeframes and describe provision of adjunctive services to address substance use. Studies generally found negative associations with opioid abstinence during treatment among patients receiving methadone or sustained-release naltrexone implants, though observed associations may have been confounded by other polysubstance use. Most studies examining opioid abstinence during other types of MOUD treatment had small samples. Conclusions Overall, existing research suggests people who use methamphetamine/amphetamines may have lower receipt of MOUD, retention in MOUD, and opioid abstinence during MOUD. Future research should examine how specific policies and treatment models impact MOUD outcomes for these patients, and seek to understand the perspectives of MOUD providers and people who use both opioids and methamphetamine/amphetamines. Efforts to improve MOUD care and overdose prevention strategies are needed for this population.
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Affiliation(s)
- Madeline C Frost
- Department of Health Systems and Population Health, University of Washington School of Public Health, 1959 NE Pacific St, WA, 98195, Seattle, United States. .,Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, United States.
| | - Hannah Lampert
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - Judith I Tsui
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - Matthew D Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, 1959 NE Pacific St, WA, 98195, Seattle, United States.,Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, United States
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Edsall A, Hoffman KA, Thuy DT, Mai PP, Hang NT, Khuyen TT, Trang NT, Kunkel LE, Giang LM, Korthuis PT. Use of methamphetamine and alcohol among people with opioid use disorder and HIV in Vietnam: a qualitative study. BMC Public Health 2021; 21:1718. [PMID: 34548042 PMCID: PMC8456677 DOI: 10.1186/s12889-021-11783-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam. METHODS We conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants' experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach. RESULTS Of 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV. CONCLUSIONS Participant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally. TRIAL REGISTRATION BRAVO - NCT01936857 , September 2013.
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Affiliation(s)
- Andrew Edsall
- Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Kim A Hoffman
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
| | - Dinh Thanh Thuy
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Pham Phuong Mai
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Nguyen Thu Hang
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
| | - Tong Thi Khuyen
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Nguyen Thu Trang
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Lynn E Kunkel
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
| | - Le Minh Giang
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - P Todd Korthuis
- Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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11
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Stockton MA, Mughal AY, Bui Q, Greene MC, Pence BW, Go V, Gaynes BN. Psychometric performance of the perceived stigma of substance abuse scale (PSAS) among patients on methadone maintenance therapy in Vietnam. Drug Alcohol Depend 2021; 226:108831. [PMID: 34225222 PMCID: PMC9830006 DOI: 10.1016/j.drugalcdep.2021.108831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND People who inject drugs (PWID) and patients on methadone maintenance therapy (MMT) face severe stigma and discrimination. However, there are limited measures assessing stigma towards individuals with substance use disorders or MMT patients, particularly in Vietnam, and few studies have examined the psychometric properties of existing measures. This study aims to examine the performance of the eight-item Perceived Stigma of Substance Abuse Scale (PSAS), created in the United States, among a population of MMT patients in Vietnam. METHODS A cross-sectional survey was conducted among 400 adult patients enrolled in an urban MMT clinic. Substance use stigma was measured using the PSAS. We conducted confirmatory factor analysis (CFA) and assessed construct validity, reliability and known-group validity. RESULTS The original eight-item scale was unidimensional, but yielded mixed goodness-of-fit indicators. Ultimately, dropping two items and allowing the errors of the items related to childcare to correlate improved the goodness-of-fit indicators. (RMSEA = 0.025; CFI = 0.999; and SRMR = 0.018). The shortened scale demonstrated acceptable reliability (Cronbach's α = 0.766). The mean stigma scores were significantly higher among individuals not working, but did not significantly vary by length of time in MMT, marital status, education attainment, HIV status, depression, concurrent injection drug use or missed methadone dose. CONCLUSIONS The shortened six-item scale demonstrated good construct validity and acceptability reliability, but it did not demonstrate many a priori hypothesized known-group validity associations. Further research should consider a mixed-methods validation approach.
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Affiliation(s)
- Melissa A. Stockton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 630 W 168th St, New York, NY, 10032, USA,New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA,Corresponding author: (MAS)
| | - Anisa Y. Mughal
- The University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Quynh Bui
- The UNC Vietnam Office, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Yen Hoa Ward, Cau Giay District, Hanoi
| | - M. Claire Greene
- Columbia University Mailman School of Public Health, Program on Forced Migration, Heilbrunn Department of Population and Family Health, 722 W 168th St, New York, NY, 10032, USA
| | - Brian W. Pence
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Epidemiology Department, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Vivian Go
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Bradley N. Gaynes
- University of North Carolina at Chapel Hill School of Medicine, Department of Psychiatry, 333 S Columbia St, Chapel Hill, NC 27516, USA
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Mughal AY, Stockton MA, Bui Q, Go V, Pence BW, Ha TV, Gaynes BN. Examining common mental health disorders in people living with HIV on methadone maintenance therapy in Hanoi, Vietnam. Harm Reduct J 2021; 18:45. [PMID: 33892743 PMCID: PMC8063421 DOI: 10.1186/s12954-021-00495-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam. METHODS This cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance. RESULTS Of the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed. CONCLUSION There is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.
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Affiliation(s)
- Anisa Y Mughal
- School of Medicine, The University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Melissa Ann Stockton
- Epidemiology Department, University of North Carolina At Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Quynh Bui
- The UNC Vietnam Office, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Yen Hoa Ward, Cau Giay District, Hanoi, Vietnam
| | - Vivian Go
- Department of Health Behavior, University of North Carolina At Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Brian W Pence
- Epidemiology Department, University of North Carolina At Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Tran Viet Ha
- The UNC Vietnam Office, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Yen Hoa Ward, Cau Giay District, Hanoi, Vietnam
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina At Chapel Hill School of Medicine, 333 S Columbia St, Chapel Hill, NC, 27516, USA
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Edsall A, Dinh TTT, Mai PP, Hoffman K, Nguyen HT, Khuyen TT, Trang NT, Bart G, Giang LM, Korthuis PT. Provider Perspectives on Integration of Substance Use Disorder and HIV Care in Vietnam: A Qualitative Study. J Behav Health Serv Res 2021; 48:274-286. [PMID: 32940824 PMCID: PMC7965786 DOI: 10.1007/s11414-020-09730-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNAIDS recommends integration of medications for substance use disorders (SUD) with HIV care to improve HIV outcomes. Yet, integration of HIV and SUD services remains limited in many countries. The objective of this study was to assess provider perceptions of care integration in Vietnam. Qualitative interviews were conducted with 43 providers (nurses, physicians, counselors, pharmacists, and clinic managers) in 8 HIV clinics in northern Vietnam, 2013-2015. Providers identified five themes informing HIV and SUD treatment integration: (1) treatment for alcohol use disorder is often neglected compared to other SUD treatment; (2) structural challenges must be addressed to increase integration feasibility; (3) workforce limitations; (4) societal and healthcare stigmatization of SUD; and (5) providers' conflicting views regarding integration challenges. The experience of providers in Vietnam may be useful to other countries attempting to integrate HIV and SUD services.
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Affiliation(s)
- Andrew Edsall
- Oregon Health & Science University School of Medicine, Portland, OR, USA
| | | | | | - Kim Hoffman
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR, USA.
| | - Hang T Nguyen
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR, USA
| | | | | | - Gavin Bart
- Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| | | | - P Todd Korthuis
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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14
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Managing amphetamine use is critical to achieving HIV control. AIDS 2020; 34:1971-1973. [PMID: 32558661 PMCID: PMC7575016 DOI: 10.1097/qad.0000000000002611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen T, Zhong N, Du J, Li Z, Zhao Y, Sun H, Chen Z, Jiang H, Zhao M. Polydrug use patterns and their impact on relapse among heroin-dependent patients in Shanghai, China. Addiction 2019; 114:259-267. [PMID: 30276902 DOI: 10.1111/add.14451] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/15/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
Abstract
AIMS To describe the polysubstance use patterns of heroin-dependent patients and to understand the impact of polysubstance use patterns on relapse during the 5 years after completing compulsory rehabilitation programmes. DESIGN In this secondary analysis, the baseline data of 503 heroin-dependent patients were linked with their 5-year follow-up data from official records. SETTING Four compulsory rehabilitation centres in Shanghai, China. PARTICIPANTS A total of 564 heroin-dependent patients who were discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008 were recruited. Among these, 503 patients with available follow-up records were included in this analysis. MEASUREMENTS The baseline measurements included the Addiction Severity Index, the Temperament and Character Inventory and the Medical Outcomes Study Social Support Scale. Relapses after discharge from the compulsory rehabilitation centres were extracted monthly from the official electronic record system. Latent class analysis was used to identify different polysubstance use patterns. Associations between the identified latent classes and heroin use and the factors related to relapse during the 5-year follow-up were analysed with the Cox regression model. FINDINGS Three latent classes were identified in this cohort: (1) alcohol polydrug users (APU; 13.7%), (2) low polydrug users (LPU; 76.5%) and (3) amphetamine-type stimulant polydrug users (ASPU; 9.7%). During the 5-year follow-up, 298 heroin patients relapsed, and the three groups showed different relapse rates (ASPU 69.4 versus LPU 60.5 versus APU 44.9%, P = 0.02). The average durations of abstinence for the three groups differed (ASPU 31.27 ± 3.41 months versus LPU 36.77 ± 1.19 months versus APU 42.46 ± 2.81 months, P = 0.02). Multivariate Cox regression analyses found that the LPU [hazard ratio (HR) = 1.63, 1.06-2.51] and ASPU (HR = 2.10, 1.24-3.56) classes were positively associated with the risk of heroin relapse. CONCLUSION Polydrug use patterns differ among heroin-dependent patients in compulsory rehabilitation programmes in China. A history of polydrug use may predict heroin relapse risk among patients in those compulsory rehabilitation programmes.
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Affiliation(s)
- Tianzhen Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhibin Li
- Jiading Mental Health Center, Shanghai, China
| | - Yan Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiming Sun
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhikang Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Grall-Bronnec M, Laforgue EJ, Challet-Bouju G, Cholet J, Hardouin JB, Leboucher J, Guillou-Landréat M, Victorri-Vigneau C. Prevalence of Coaddictions and Rate of Successful Treatment Among a French Sample of Opioid-Dependent Patients With Long-Term Opioid Substitution Therapy: The OPAL Study. Front Psychiatry 2019; 10:726. [PMID: 31681038 PMCID: PMC6812413 DOI: 10.3389/fpsyt.2019.00726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/10/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Opioid use disorder (OUD) is a worldwide major health concern due to increased early mortality and morbidity. Opioid substitution therapy (OST) is approved in the context of a global OUD treatment (OUDT), in conjunction with psychosocial interventions. Many factors can explain why unsuccessful treatment rates remain high. While the phenomenon of addiction switching is often proposed, it is not known whether this also includes gambling addiction. The primary objective of the OPAL study was to determine the prevalence of coaddictions, including problem gambling, among patients with OUDT. Secondary objectives were to assess the rate of unsuccessful OUDT and to characterize the associated factors. Methods: For this observational transversal multicenter study, patients with OUDT including OST for at least 6 months were recruited. Clinical assessment was based on a clinically structured interview and a set of self-reported questionnaires. Coaddictions were screened using the Fagerström, the CRAFFT, and the Lie/Bet questionnaires. Unsuccessful OUDT was defined as the persistence of opioid use and/or the worsening of another substance use or gambling practice. After a descriptive analysis, a multivariate analysis was performed to identify the factors associated with unsuccessful OUDT. Results: The sample consisted of 263 patients. Prevalence of coaddictions reached 97% of the sample. Problem gambling was associated with 10% of the patients. OUDT was considered as "unsuccessful" for 60% of the patients. Associated factors included having drug-using friends, psychiatric and professional negative consequences related to opioid use, more than one OST-prescribing physician, and impulsivity, especially high scores for lack of premeditation and sensation seeking. Conclusions: This study provides further evidence of the need to consider coaddictions and the usefulness of global addictive evaluations. Poor prognostic factors must alert the clinician to initiate more sustained care. Further implications are discussed.
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Affiliation(s)
- Marie Grall-Bronnec
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,HUGOPSY Network, Nantes, France
| | - Edouard-Jules Laforgue
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France
| | - Gaëlle Challet-Bouju
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France
| | - Jennyfer Cholet
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France
| | - Jean-Benoit Hardouin
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Methodology and Biostatistic Department, DRCI, CHU Nantes, Nantes, France
| | - Juliette Leboucher
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France
| | - Morgane Guillou-Landréat
- HUGOPSY Network, Nantes, France.,Addictive Medicine Department, CHU Brest, Brest, France.,Université de Bretagne Occidentale, ERCR SPURBO, Brest, France
| | - Caroline Victorri-Vigneau
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France
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