Continued drug use during methadone treatment in China: a retrospective analysis of 19,026 service users

Opioid relapse and its predictors among methadone maintenance patients: a multicenter, cross-sectional study in Vietnam

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.

Exploring factors jointly associated with recurrent relapse and dropout of methadone maintenance treatment clients in Guangdong, China: A retrospective cohort study

BACKGROUND

Clients receiving methadone maintenance treatment (MMT) may experience multiple relapses, which may lead to dropout. However, previous studies mostly only explored the influencing factors of relapse or dropout separately. In this study, we investigated the influencing factors jointly associated with both recurrent relapse and dropout.

METHODS

This study was conducted in 16 MMT clinics in Guangdong, China. Data on the clients' demographic characteristics; drug-related behavior; HIV, HCV, and urine morphine test results; and daily methadone doses were collected. The outcomes were time to recurrent relapse and time to dropout. A joint frailty model was used to explore factors jointly associated with recurrent relapse and dropout. The hazard ratios (HRs) of the covariates in the multivariable model were adjusted, with HR > 1 indicating a faster time to recurrent relapse and dropout.

RESULTS

Among 1539 clients, 39.5% had ≥ 2 relapse events, and 90.8% of the clients dropped out. A high attendance rate was protective for recurrent relapse (HR_50-80%=0.63, 95% CI: 0.51, 0.79; HR_>80%=0.35, 95% CI: 0.28, 0.44) and dropout (HR_50-80%=0.56, 95% CI: 0.47, 0.68; HR_>80%=0.27, 95% CI: 0.23, 0.33). Being married (HR=0.80, 95% CI: 0.67, 0.96), having a fair relationship with family (HR=0.79, 95% CI: 0.67, 0.93) and drug injection (HR=0.80, 95% CI: 0.67, 0.96) were also protective for recurrent relapse. Female (HR=0.64, 95% CI: 0.50, 0.82) and a high methadone dose (≥60 ml/day; HR=0.79, 95% CI: 0.65, 0.96) were protective for dropout, and a longer traveling time to the clinic (>60 min; HR=1.59, 95% CI: 1.20, 2.10) was associated with an increased risk of dropout.

CONCLUSIONS

It is common for clients to experience recurrent relapse and dropout. The findings suggest that MMT clinics should provide holistic interventions and appropriate methadone doses for clients to improve treatment compliance.

Continuity of illicit drug use among Malay patients attending methadone clinics in Kelantan, Malaysia

The study aimed to determine the prevalence of continuity of illicit drug use and its associated factors among Malay opioid users receiving methadone treatment in Kelantan, Malaysia. This cross-sectional study involved a total of 150 respondents. Sociodemographic characteristic of participants, level of religiosity, and quality of life were collected using the self-administered questionnaires. The prevalence of continuity illicit drug use was 38.7% (n = 58) by self-report and 40.7% (n = 61) by positive urine test result for drugs. Positive hepatitis C status and high quality of life in the psychological health domain were associated with low continuity of illicit drug use by self-reported data and urine drug test results. In conclusion, the continuity of illicit drug use among methadone program users is still high, especially among those on methadone therapy for less than 2 years.

Automatic Detoxification Medicine Delivery by Thermo-Sensitive Poly(ethylene glycol)-Based Nanogels

During the medication-assisted treatment of drug abuse, side effects and addiction liabilities are commonly observed. Thus, control of the medication dose is very important. According to body temperature abnormalities in drug abusers, a thermo-sensitive nanogel was synthesized as a drug carrier to automatically deliver detoxification medicines. This nanogel was prepared through the synthesis of polystyrene (PS) core microspheres, followed by coverage with a nonlinear poly(ethylene glycol)-based copolymer shell. The PS core microspheres were found to be an ideal hydrophobic core for loading the detoxification medicines effectively. The nonlinear poly(ethylene glycol)-based copolymer shell layer consisted of 2-(2-methoxyethoxy)ethyl methacrylate (MEO2MA) and oligo(ethylene glycol) methyl ether methacrylates (Mn = 300 g mol-1, MEO5MA). The monomer feeding molar ratio n(MEO2MA)/n(MEO5MA) of 1:3 enabled PS@P(MEO2MA-co-MEO5MA) nanogels to exhibit a distinguished colloidal stability and an adjustable volume phase transition temperature which is within the drug addicts' abnormally fluctuating temperature range. Importantly, it was found that the obtained PS@P(MEO2MA-co-MEO5MA) nanogels displayed good biocompatibility with rat aortic endothelial cells in the given concentration range. The nanogels also exhibited a satisfactory loading efficiency and thermo-sensitive/sustained release characteristics for three detoxification medicines: sinomenine, diltiazem and chlorpromazine.

Effect of Coronavirus Disease 2019 on the Psychology and Behavior of Patients on Methadone Maintenance Treatment in Wuhan, China: A Clinical Observational Study

Methadone maintenance treatment (MMT) is a national strategy adopted for the treatment of heroin dependency in China. The sudden outbreak of coronavirus disease 2019 (COVID-19) and the resultant social isolation in Wuhan have also had a significant negative impact on local patients undertaking MMT. In this study, 76 patients on MMT from the Wuhan First Health Clinic were selected as the research objects to investigate the effect of COVID-19 on the levels of stress, anxiety, and depression, as well as the withdrawal symptoms and craving and substance use. Our results revealed that, during the outbreak, the Perceived Stress Scale (PSS) score, HAMA score, HAMD score, and craving in the included patients was significantly higher than that at the baseline and post-epidemic (p < 0.01, p < 0.01, p < 0.01, p < 0.01, respectively); the positive rate of morphine and methamphetamine urine test was significantly lower than that the post-epidemic (p = 0.01, p < 0.01, respectively); the amount of tobacco used during the outbreak and the post-epidemic period was significantly higher than that at the baseline (p < 0.01, p < 0.01, respectively), while the amount of alcohol consumed at the outbreak was significantly higher than at the baseline and the post-epidemic (p < 0.01, p < 0.01, respectively). The negative emotions aroused by the COVID-19 outbreak and the accompanying social isolation to patients on MMT are an important factor of negative reinforcement that adversely affected the patients' craving for drugs and the consumption of legal substances. This finding suggests the need to strengthen the psychological counseling for patients on MMT during severe epidemic, actively alleviating the negative emotions, reducing the risk of substance abuse, and strengthening drug management after the epidemic to prevent the rise of substance (legal or illegal) abuse.

Childhood Trauma, Cognitive Emotion Regulation and Motivation for Behavior Change Among Clients of Opioid Substitution Treatment With and Without Past Year Synthetic Cathinone Use During Therapy

Background

With a decrease in heroin's purity and availability in the European drug market, Hungarian opioid dependent patients started to substitute heroin with novel psychoactive substances (NPS) and especially with synthetic cathinones.

Goal

This study aims to assess whether clients of opioid substitution treatment (OST) with and without a history of synthetic cathinone use during therapy differ in (1) the rate and type of experienced childhood trauma, (2) the way they cope with negative life events, (3) their motivation to change substance use behavior, (4) the rate of treatment retention.

Methods

A total of 198 clients of an outpatient centers (Nyírõ Gyula National Institute of Psychiatry and Addictions, Budapest) OST were asked to provide information about their general substance use experiences, including the consumption of NPS during treatment, their childhood traumatic experiences (Childhood Trauma Questionnaire), cognitive emotion regulation strategies (Cognitive Emotion Regulation Questionnaire), their motivation to change substance use behavior (University of Rhode Island Change Assessment Scale) and current psychiatric symptoms (Brief Symptom Inventory). Baseline data was collected in the summer of 2015, while 4 years follow-up data on treatment retention was obtained in the summer of 2019.

Results

The majority of the clients were male (N = 141, 71.2%), receiving methadone as a substitute for opioids (N = 178, 89.9%), while mean age of the full sample was 39.7 (SD = 6.8). Based on a logistic regression model, the odds for past year synthetic cathinone use was higher among clients with more severe psychiatric symptoms (B = 0.8, OR = 2.2, p < 0.01) and among clients who were in treatment for a shorter period of time (B = 0.1, OR = 0.9, p < 0.05). Synthetic cathinone use during treatment was further associated with less adaptive strategies to cope with negative life events. Synthetic cathinone use was also a risk factor for reduced treatment retention (B = -0.8, OR = 0.4, p < 0.05) and was associated with lower odds of being member of a latent class with less severe psychopathological profile (B = -0.9, OR = 0.4, p < 0.05).

Conclusion

Synthetic cathinone use during treatment is associated with poorer treatment outcomes and might be characterized by more severe psychiatric symptoms and amotivation to change substance use among opioid dependent clients.

The Association between Living Status Transitions, Behavior Changes and Family Relationship Improvement among Methadone Maintenance Treatment Participants in Guangdong, China

The quality of family relationships is important for individual and family well-being. Improving family relationships is also an important goal in methadone maintenance treatment (MMT). Little is known about factors associated with the improvement of family relationships among MMT clients. This study aimed to identify factors associated with family relationship improvement in MMT. We retrospectively analyzed existing data from 2006 to 2014 at 15 MMT clinics in Guangdong, China, including 2171 subjects with 4691 follow-ups. Generalized estimating equations were used to investigate the association between living status transitions, behavior changes and family relationship improvement, with covariates controlled for. Family relationship improvement was found in 23.1% of all follow-up intervals. Participants who began living with family, living on a regular wage, and gained employment were more likely to have improved family relationships. The quality of family relationships also improved among participants who ceased contact with drug-addicted fellows, ceased drug use, and those who were sexually active. These results suggest that improvement in living status, positive changes in drug use, and sexual activity are associated with family relationship improvement and corresponding interventions may be developed to facilitate clients' recovery.

The Decade-Long Chinese Methadone Maintenance Therapy Yields Large Population and Economic Benefits for Drug Users in Reducing Harm, HIV and HCV Disease Burden

Objectives: We aimed to conduct a comprehensive evaluation of the population impact of methadone maintenance treatment (MMT) for its future program planning.

Methods: We conducted a literature review of the effects of MMT in China on HIV and HCV disease burden, injecting, and sexual behaviors and drug-related harm during 2004–2015. Data synthesis and analysis were conducted to obtain the pooled estimates of parameters for a mathematical model which was constructed to evaluate the effectiveness and cost-effectiveness of the program.

Results: Based on a review of 134 articles, this study demonstrated that MMT is highly effective in reducing crime-related, high risk sexual, and injecting behaviors. The model estimated US$1,037 m which was invested in MMT from 2004 to 2015 has prevented 29,463 (15,325–43,600) new HIV infections, 130,563 (91,580–169,546) new HCV infections, 10,783 (10,380–11,187) deaths related to HIV, HCV and drug-related harm, and 338,920.0 (334,596.2–343,243.7) disability-adjusted life years (DALYs). The costs for each prevented HIV infection, HCV infection, death, and DALY were $35,206.8 (33,594.8–36,981.4), $7,944.7 ($7,714.4–8,189.2), $96,193.4 (92,726.0–99,930.2), and $3,060.6 ($3,022.0–3,100.1) respectively.

Conclusion: The Chinese MMT program has been effective and cost-effective in reducing injecting, injecting-related risk behaviors and adversities due to HIV/HCV infection and drug-related harm among drug users.

Effect of community-based extension clinics of methadone maintenance therapy for opiate-dependent clients: A prospective cohort study in Dehong Prefecture, Yunnan Province of China

Methadone maintenance therapy (MMT) is effective in treatment of opiate dependents. However, there is a gap between the coverage of standard MMT clinics and the need of opiate dependents. Establishment of extension clinics of methadone maintenance therapy (EMMT) will increase the coverage and improve MMT accessibility. We implemented a prospective cohort study to understand the effects of establishment of community-based EMMT clinics comparing with MMT clinics in Yunnan Province.A total of 462 opiate-dependent clients were interviewed from the community-based EMMT clinics and standard MMT clinics located in 5 counties of Mangshi, Ruili, Longchuan, Yingjiang, and Lianghe in Yunnan Province. The information on the demographic characteristics, drug risk behaviors, quality of life (QOL), and urine testing results for morphine of the clients was collected and compared between the EMMT and MMT clinics. A survival analysis method was utilized to know the retention situation of the newly enrolled clients with Kaplan-Meier method during 9 months treatment.Among the EMMT clients, 96.9% were male; 31.4% were Han; 61.4% were married; 39.0% had primary school education; 95.5% lived with their family or relatives; 96.9% who arrived the clinic less than 15 min; 52.9% had used drugs for more than 10 years; and 16.7% injected drug. After 9 months therapy, there was no difference in the changes of life quality such as physical and psychological features, social relationships, environmental function, and total QOL and well-being between those of EMMT and MMT clinics. The positive detection rate of urine-morphine testing among newly enrolled clients of EMMT clinics decreased as the period of treatment lengthened. The average time of retention for newly enrolled EMMT clients who are still receiving the treatment was 175 days. And the average time from initiations to drop-out of treatment for newly enrolled EMMT clients was 122 days. The 9-month retention rates of the clients were 52.1% and 60.9% at EMMT and MMT clinics, respectively.The effect on EMMT retention was the same as that of MMT. Establishment of EMMT clinics was an effective strategy to expand the coverage of MMT and increase the retention of opiate dependents in the rural areas of the counties.

GRK5 Is Associated with the Regulation of Methadone Dosage in Heroin Dependence

Background

There is no countable biomarker for opioid dependence treatment responses thus far. In this study, we recruited Taiwanese methadone maintenance treatment patients to search for genes involving the regulatory mechanisms of methadone dose by genome-wide association analyses.

Methods

A total of 344 Taiwanese methadone maintenance treatment patients were included in a genome-wide association study. The involvement of GRK5 in opioid dependence was then further confirmed by gene expression study on lymphoblastoid cell lines derived from 3 independent age- and gender-matched groups: methadone maintenance treatment patients, medication-free former heroin abusers, and normal controls.

Results

The results indicated that GRK5, the gene encoding an enzyme related to μ-opioid receptor desensitization, is associated with methadone dose by additive model of gene-based association analysis (P=6.76×10-5). We found that 6 of the 55 single nucleotide polymorphisms from the genome-wide genotype platform and 2 single nucleotide polymorphisms from the 29 additionally selected single nucleotide polymorphisms were significantly associated with methadone maintenance dose in both genotype and allele type (P ≤ .006), especially in patients who tested negative in the urine morphine test. The levels of GRK5 gene expression were similar between methadone maintenance treatment patients and medication-free former heroin abusers. However, the normal controls showed a significantly lower level of GRK5 gene expression than the other groups (P=.019).

Conclusions

The results suggested an important role for GRK5 in the regulatory mechanisms of methadone dose and course of heroin dependence.

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

BACKGROUND

The 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.

OBJECTIVES

In this study, we explored the relationship between family-related factors and concurrent heroin use during MMT in China.

METHODS

This 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.

RESULTS

Of 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).

CONCLUSIONS

The 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.

Influence of social network on drug use among clients of methadone maintenance treatment centers in Kunming, China

AIMS

To examine drug use behavior of clients attending Methadone Maintenance Treatment (MMT) programs and its relationship with the clients' social network characteristics.

DESIGN

Cross-sectional study.

SETTING

Four MMT clinics in Kunming, Yunnan province, China.

PARTICIPANTS

324 consecutive MMT clients.

MEASUREMENTS

A structured, self-completed questionnaire on background characteristics and existing social network. Current drug use was assessed by urine test for opiate metabolites.

ANALYSIS

The association between client's social network characteristics and their own current drug use behavior is analysed using multiple logistic regression adjusting for socio-demographic characteristics. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are obtained to give the strength of the associations.

FINDINGS

MMT clients were more likely to concurrently use heroin while attending MMT if their social network had any of the following characteristics: more than half of the members were older than them (AOR = 1.03, 95% CI = 1.00,1.06), any member had a high level of influence on them (AOR = 6.47, 95% CI = 2.86,14.65) and any member joined them in using drugs (AOR = 1.94, 95% CI = 1.04,3.63). Having a social network member who could provide emotional support (AOR = 0.11, 95% CI = 0.03,0.35), having a spouse and/or child in their social network (AOR = 0.44, 95% CI = 0.24,0.81) and having a social network member with a high level of closeness (AOR = 0.28, 95% CI = 0.09,0.90) were associated with a decreased odds of heroin use.

CONCLUSION

Social networks who could provide MMT clients with emotional support and a close relationship were significant factors for reducing the risk of concurrent drug use among clients attending MMT clinics in Kunming, China. Behavioral interventions should address the role of family and social network members in providing support to these clients.

Concurrent drug injection during opioid agonist treatment among people who inject drugs in Ukraine

Ongoing drug use during opioid agonist treatment (OAT) negatively affects treatment and health outcomes, and increases treatment dropout. This study aimed to examine correlates of concurrent illicit drug use among OAT patients in Ukraine. A random sample of 434 patients currently on OAT receiving buprenorphine (BMT) or methadone maintenance treatment (MMT) from five cities in Ukraine were assessed for factors associated with self-reported concurrent illicit drug use during OAT using a multivariable logistic regression. Among 434 OAT patients, 100 (23%) reported concurrent drug injecting in the previous 30 days; 28% of these were injecting ≥20 days. While 100 (100%) of these injected opioids, 24 (24%) injected stimulants; 40 (40%) met criteria for polysubstance use disorder that included opioids, stimulants and alcohol. Independent correlates of concurrent drug injection included: being on MMT vs. BMT (aOR = 2.8, 95%CI = 1.4-5.8), lower OAT dosage (aOR = 1.7, 95%CI = 1.1-2.7), more severe addiction severity (aOR = 2.3, 95%CI = 1.4-3.8), younger age of injection initiation (aOR = 2.3, 95%CI = 1.3-3.9), and presence of alcohol use disorder (aOR = 2.1, 95%CI = 1.3-3.5); participants living with parents were negatively associated with concurrent drug injection. Concurrent drug use was prevalent among OAT patients in Ukraine indicating the urgent needs for tailored interventions and changes in OAT program design and implementation. Results highlight the importance of prescribing an adequate OAT dosage, and discrepancies between MMT and BMT programs in Ukraine addressing needs of OAT patients with specific characteristics such as severe opioid and alcohol dependence.

Concurrent drug use among methadone maintenance patients in mountainous areas in northern Vietnam

OBJECTIVES

With the rise in methadone maintenance therapy (MMT) for drug users in Vietnam, there has been growing interest in understanding if and how often MMT patients engage in concurrent illicit drug use while on methadone therapy in various settings. This study examined factors associated with concurrent opioid use among patients on MMT in a mountainous area in Vietnam.

SETTING

One urban and one rural MMT clinics in Tuyen Quang province.

PARTICIPANTS

Survey participants consisted of patients who were taking MMT at the selected study sites. A convenience sampling approach was used to recruit the participants.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants were asked a series of questions about their socioeconomic status, current alcohol and tobacco use, health problems (measured by the EuroQol-Five Dimension-Five Level instrument), psychological distress (measured by Kessler score), and factors associated with current and/or previous drug use. Regression models were used to determine factors associated with concurrent drug use among MMT patients.

RESULTS

Among the 241 male MMT patients included in the study, 13.4% reported concurrent opioid use. On average, the longer patients had been enrolled in MMT, the less likely they were to concurrently use drugs. Conversely, patients with higher levels of psychological distress were more likely to engage in concurrent drug use while on MMT.

CONCLUSION

Longer duration of MMT was significantly correlated with reduced illicit drug use among participants. Higher levels of psychological distress were associated with increased use of illicit drugs among MMT patients. Regardless of distance, long-term MMT is still effective and should be expanded in mountainous areas.

Factors associated with concurrent heroin use among patients on methadone maintenance treatment in Vietnam: A 24-month retrospective analysis of a nationally representative sample

BACKGROUND

Methadone maintenance treatment (MMT) is highly effective for reducing heroin use and HIV transmission among people who inject opioids. We sought to measure and understand factors associated with continued heroin use, a critical factor affecting treatment outcome among MMT patients in Vietnam.

METHOD

We collected data from medical charts of a nationally representative sample of patients who were on MMT from May 2008 to December 2013. We selected 10 MMT clinics using probability proportional to size and 50 patients/clinic by systematic random sampling. Concurrent heroin use was defined by self-report/positive urine test recorded in patient charts during month 3, 6, 12, and 24 after MMT initiation. We used multivariable logistic regression to identify factors associated with concurrent heroin use over the first 24 months in treatment.

FINDINGS

All clients used heroin at baseline; concurrent heroin use was 55% at month 3; 19%, 14.6% and 15.2% at month 6, 12, and 24, respectively. Having no family emotional/financial support at baseline versus having this support (AOR = 2.03; 95% confidence interval [CI] = 1.17-3.53); using heroin for <15 years versus ≥15 years at baseline (AOR = 1.55; 95% CI = 1.01-2.38); being HIV-infected/not on antiretroviral treatment (ART; AOR = 1.79; 95% CI = 1.07-2.98) or being HIV infected/on ART (AOR = 2.39; 95% CI = 1.61-3.55), versus not being HIV infected; baseline methamphetamine use versus non-use (AOR = 2.68; 95% CI = 1.08-6.65), were associated with increased odds of concurrent heroin use among patients.

CONCLUSION

The association between concurrent heroin use among MMT patients and lack of family emotional/financial support, highlights the critical importance of these types of support for successful treatment. Association with shorter heroin use history suggests motivational enhancement may reduce concurrent heroin use. Living with HIV, whether on ART or not, is associated with increased concurrent heroin use and suggests safe injection commodities and education, and drug-drug interaction management, are needed for this subgroup. Though few MMT clients reported baseline methamphetamine use, its association with later heroin use suggests the need for effective methamphetamine use interventions.

[Substance abuse detection in substitution therapy : Oral fluid versus urine screening]

BACKGROUND

A patient's health in an opioid maintenance program is potentially endangered due to concurrent consumption of drugs. Therefore, the German Medical Association requests evidence of compliant substitute intake while type and frequency of drug screening is chosen by the physician. This study comparatively assessed the feasibility and potential advantage of oral fluid drug testing versus urine screening in day-to-day practice.

METHODS

Urine and oral fluid-samples of a randomly chosen third of a total of 361 patients, treated in four different practices in a major German city, were tested. The detection rates were compared bivariate and the illicit substance intake of subgroups were analysed. Additionally, patients' and employees' satisfaction with the test procedures were assessed.

RESULTS

A total of 117 paired urine and oral fluid samples were considered for this study. A dual sample collection was not obtainable with 29 patients due to insufficient sample volume or refusal. Other than methadone or buprenorphine, 155 substances were found in urine samples, whereas only 82 other substances were detected in oral fluids. Significant differences existed within substance groups with THC being positive in 50 (42.7%) urine samples and only three (2.6%) positive oral fluid samples (p < 0.0001) and with benzodiazepines with 41 (35%) positive urine and 28 (23.9%) positive oral fluid samples (p < 0.0001), respectively. In total 75.2% of the urine samples were positive for concurrent drug consumption. Employees and patients did not prefer one test type over the other.

CONCLUSION

The confirmation of concurrent drug intake in maintenance setting is generally possible by the use of oral fluid, but inferior to urine screening.

Comparison Between Urinalysis Results and Self-Reported Heroin Use Among Patients Undergoing Methadone Maintenance Treatment in China

BACKGROUND

The validity and concordance of two main measures of drug use behavior, self-report and urinalysis, has long been discussed. More understanding is needed about the underlying factors associated with discordance between these two methods.

OBJECTIVES

Describe the pattern and associated factors of discordance between self-reported heroin use and the urinalysis results of opiate use among methadone maintenance therapy (MMT) patients in China.

METHODS

A total of 2,448 MMT patients from 68 clinics in five provinces of China participated in a survey, which collected information on demographics, drug use and MMT-related factors, depressive symptoms, and drug avoidance self-efficacy. The most recent urine morphine test result was obtained from medical records and compared with self-reported heroin use. Participants who had urinalysis within 14 days of the survey were included in the analysis.

RESULTS

Among the 1,092 participants, 70 (6.4%) self-reported heroin use and 195 (17.9%) had positive urinalysis results. The over-reporters group had significantly higher education, and the under-reporters had significantly higher level of drug-avoidance self-efficacy and lower level of depressive symptoms. Among the participants who either self-reported heroin use or had positive urinalysis results, being young, having higher education, and having lower level of depressive symptoms were associated with discordance between self-reports and urinalysis results.

CONCLUSION

The combination of both measures in assessing drug use behavior seems necessary. The validity of self-report should be considered differently based on demographic and psychosocial characteristics.

Positive percentages of urine morphine tests among methadone maintenance treatment clients with HIV/AIDS: a 12-month follow-up study in Guangdong Province, China

OBJECTIVE

We aimed to assess the positive percentages of urine morphine tests and correlates among methadone maintenance treatment (MMT) clients with HIV/AIDS in Guangdong, China.

SETTING

Fourteen MMT clinics located in nine cities of Guangdong were chosen as study sites.

PARTICIPANTS

In this study, we reviewed 293 clients with opioid dependence, who were HIV seropositive, 18 years or older, provided informed consent and had at least 10 records of urine morphine tests during the study period.

PRIMARY AND SECONDARY OUTCOME MEASURES

The positive percentages of urine morphine tests were calculated and underlying predictors were estimated.

RESULTS

The highest positive percentage (95.9%) was observed in the first month. After excluding the highest percentage in the first month, the average positive percentage was 40.9% for month 2 to month 12. Positive percentages of urine morphine tests that were <20%, 20-60% and >80% were 25.4%, 36.1% and 38.5% respectively. Lower percentages of continued heroin use were associated with being young (OR≤30=0.31, 95% CI 0.12 to 0.78; OR31-=0.44, 95% CI 0.20 to 1.00), and financial sources depending on family or friends (OR=0.55, 95% CI 0.32 to 0.93). Higher percentages of continued heroin use were associated with being unemployed (OR=1.99, 95% CI 1.13 to 3.49) and poor MMT attendance (OR<20%=3.60, 95% CI 1.55 to 8.33; OR20%-=2.80, 95% CI 1.48 to 5.33).

CONCLUSIONS

High positive percentages of urine morphine tests remain prevalent among MMT clients with HIV/AIDS in Guangdong. The present findings have implications for taking effective measures to facilitate attendance in order to decrease heroin use and ultimately improve the effectiveness among these sub-group MMT clients.

Factors associated with illicit opioid use in methadone maintenance treatment clients in 5 Provinces, China

OBJECTIVES

To investigate factors associated with illicit opioid use among methadone maintenance treatment (MMT) population.

METHODS

Participants were recruited from Beijing (2 clinics), Shanghai (2 clinics), Guangdong (2 clinics), Chongqing (2 clinics) and Gansu (1 clinic) provinces. Information about heroin use and MMT was obtained from a self-reported questionnaire, illicit opioid use was obtained from monthly medical records. Binary logistic regression was used to investigate factors associated with illicit opioid use.

RESULTS

Five hundred ninety-eight eligible MMT participants were used for data analysis. Variables such as age, gender, route of heroin use and daily MMT dosages were associated with illicit opioid use. Compared with MMT participants aged <40 years, participants aged 40-44 years (P = 0.027, OR = 0.57, 95 % CI 0.35-0.94), 45-49 years (P < 0.001, OR = 0.41, 95 % CI 0.24-0.67) and ≥50 years (P = 0.008, OR = 0.52, 95 % CI 0.33-0.85) were more likely not to have illicit opioid use. Compared with male participants, females were more likely to have illicit opioid use (P = 0.044, OR = 1.53, 95 % CI 1.01-2.32). Compared with inhalation heroin abusers, abusers with route of inhalation + injection heroin use were more likely to have illicit opioid use (P = 0.009, OR = 2.00, 95 % CI 1.19-3.36). Compared with daily MMT dosages <60 mg participants, participants with daily MMT dosages >80 mg were more likely to have illicit opioid use (P = 0.003, OR = 2.37, 95 % CI 1.35-4.15).

CONCLUSIONS

Age, gender, route of heroin use and daily MMT dosages were associated with illicit opioid use. A tailored intervention is needed for a promotion of MMT.

HIV seroconversion and risk factors among drug users receiving methadone maintenance treatment in China: A qualitative study

OBJECTIVE

We sought to explore the experiences of drug users in China who were recently diagnosed with HIV infection while engaged in methadone maintenance treatment (MMT) and to better understand their perceptions of MMT, HIV risk, and HIV prevention.

METHODS

We recruited clients of MMT clinics in Chongqing and Kunming who had a baseline HIV-negative test result upon entry to MMT and had been diagnosed with HIV within the past 12 months. We conducted semi-structured qualitative interviews and thematic data analysis to identify situations and factors that increased HIV risk.

RESULTS

Among the 27 participants who were interviewed, 15 believed their infection was due to injection drug use, 7 attributed their infection to sexual contact, and 5 were unsure as to how they became infected. High risk behaviors were common; 18 participants continued to use drugs during treatment, and 10 engaged in unprotected sex. Common themes were the difficulty of drug abstinence despite receiving MMT, social pressure to continue using drugs, and low knowledge of effective HIV prevention measures.

CONCLUSION

While MMT is effective in reducing drug usage and needle sharing, many clients remain at risk of HIV infection due to continued injection drug use and unprotected sex. Clients may benefit from additional counseling on HIV prevention methods as well as structural interventions to increase the availability of clean injection equipment.

How clients' during-treatment motivations relate to their perceptions and impressions of methadone maintenance treatment: A multilevel analysis of a cross-sectional survey in Guangdong Province, China

BACKGROUND

Much evidence has suggested the positive effect of methadone maintenance treatment (MMT) on mitigating adverse outcomes caused by opioid use. Pretreatment motivations are associated with clients' engagement, retention, and outcomes in drug use treatment. However, motivation is mutable, and few MMT researchers have considered during-treatment motivations and associated multilevel factors.

OBJECTIVE

We aimed to investigate during-treatment motivations and clinic- and individual-level associated factors among MMT clients in Guangdong Province, China.

METHODS

Stratified random sampling was used to select 12 MMT clinics in Guangdong Province. Between December 2011 and January 2012, a total of 802 respondents were surveyed about their motivation and multilevel factors using the following instruments: the Texas Christian University (TCU) Treatment Motivation Scales, the impression-of-detoxification scale, the National MMT Data Management System of China, and structured questionnaires. Multilevel models were employed to conduct the univariate and multivariate analyses of the factors associated with during-treatment motivations for MMT.

RESULTS

The means ± SD (95% CI) of clients' during-treatment motivations (Desire for Help and Treatment Readiness) were 2.89±0.56 (2.85, 2.93) and 2.28±0.57 (2.24, 2.32). Multilevel analyses showed that clients' educational level, perceptions, and impressions of MMT; and clinics' supportive family assistance and closing time were significantly associated with during-treatment motivations for MMT (P<0.05).

CONCLUSIONS

During-treatment motivation may play a significant role in the success of MMT. There is a need for improving motivation among Chinese MMT clients, and the knowledge of associated factors may guide more effective program in the future.

Concurrent Heroin Use and Correlates among Methadone Maintenance Treatment Clients: A 12-Month Follow-up Study in Guangdong Province, China

Objective: To assess concurrent heroin use and correlates among Methadone Maintenance Treatment (MMT) clients in Guangdong Province, China. Method: Demographic and drug use data were collected with a structured questionnaire, and MMT information was obtained from the MMT clinic registration system in Guangdong. Human immunodeficiency virus (HIV-) and hepatitis C virus (HCV) infected status and urine morphine results were obtained from laboratory tests. Logistic regressions were employed to investigate the factors associated with concurrent heroin use. Results: Among the 6848 participants, 75% continued using heroin more than once during the first 12 months after treatment initiation. Concurrent heroin use was associated with inharmonious family relationship (OR (odds ratio) = 1.49, 95% CI (confidence intervals): 1.24–1.78), HIV positivity (OR = 1.25, 95% CI: 1.01–1.55), having multiple sex partners (OR = 1.34, 95% CI: 1.07–1.69), having ever taken intravenous drugs (OR = 0.81, 95% CI: 0.69–0.95), higher maintenance dose (OR = 1.13, 95% CI: 1.01–1.28) and poorer MMT attendance (OR_<20% = 1.32, 95% CI: 1.13–1.53; OR_20%– = 1.33, 95% CI: 1.14–1.54; OR_50%– = 1.69, 95% CI: 1.44–2.00). Among those who used heroin concurrently, the same factors, and additionally being older (OR_35– = 1.26, 95% CI: 1.11–1.43; OR_≥45 = 1.63, 95% CI: 1.30–2.05) and female (OR = 1.60, 95% CI: 1.28–2.00), contribute to a greater frequency of heroin use. Conclusions: Concurrent heroin use was prevalent among MMT participants in Guangdong, underscoring the urgent needs for tailored interventions and health education programs for this population.

Illicit Heroin and Methamphetamine Use among Methadone Maintenance Treatment Patients in Dehong Prefecture of Yunnan Province, China

Objective

Methadone maintenance treatment (MMT) was introduced to China in 2004 to reduce the harm of injecting drug users (IDUs). However, little is known about continued drug use, especially methamphetamine (MAMP), among MMT patients.

Methods

A survey was conducted among patients attending five major MMT clinics in Dehong Prefecture in 2014 to investigate the heroin and MAMP use and their associated risk factors. Participants were administered with face-to-face interviews, and urine tests for morphine and MAMP.

Results

A total of 2,121 were eligible and participated in the study. Among them, 220 (10.4%) were only positive for morphine, 12.9% were only positive for MAMP, and 196 (9.2%) were positive for both morphine and MAMP. Compared with neither use of heroin nor MAMP during MMT, heroin use (not using MAMP) was associated with ethnicity, shorter duration of MMT, lower dose of methadone, and having had no more than two sex partners in the past year; MAMP use (not using heroin) was associated with ethnicity, longer duration of MMT, higher dose of methadone and being aged <30 years (vs. ≥50 years); use of both heroin and MAMP was associated with being Dai minority (vs. Han), a marital status of divorced or widowed, having used drugs for ≥10 years and shorter duration of MMT.

Conclusion

These findings indicate the complexity in the treatment of heroin users and underscore the importance in prescribing appropriate methadone dosages in order to reduce both heroin and MAMP use.

Prevalence of depressive symptoms and associated factors among people who inject drugs in China

BACKGROUND

People who inject drugs (PWID) have a high prevalence of mental health problems (e.g., depression) which compromise the effects of HIV prevention. We investigated the prevalence of depression and associated factors among PWID in Dazhou, China.

METHODS

Anonymous face-to-face interviews were administered to eligible participants by well-trained doctors. The Center of Epidemiological Studies Depression Scale (CES-D) was used to measure depression, using hierarchical linear regression models.

RESULTS

Among the 257 participants, 7.0%, 11.3%, and 75.1% were probable cases of mild (16 ≤ CES-D < 21), moderate (21 ≤ CES-D < 25), and severe (CES-D ≥ 25) depression, respectively. Hopefulness (standardized β = -0.34, p < 0.001) and emotional family support (β = -0.21, p < 0.001) were negatively associated, whereas severity of drug dependence (β = 0.12, p = 0.034) and unmet service needs (β = 0.20, p < 0.001) were positively associated, respectively, with CES-D scores. The adjusted analysis showed that resilience was negatively associated with CES-D, but it was not selected by the stepwise model containing hopefulness and emotional family support. Protective factors (i.e., hopefulness and emotional family support) and risk factors (i.e., severity of drug dependence and unmet service needs) remained significant in the same regression model.

CONCLUSION

Protective and risk factors were independently associated with depressive symptoms. Integrated interventions covering basic and psychosocial needs for PWID are warranted. Such interventions should strengthen emotional family support and cultivate positive factors such as hopefulness.