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Chung YCE, Tung YC, Wang SC, Huang CL, Chen LY, Chen WJ. Assessing the impact of public funding in alleviating participant reduction and improving the retention rate in methadone maintenance treatment clinics in Taiwan: an interrupted time series analysis. Implement Sci 2024; 19:18. [PMID: 38389082 PMCID: PMC10885479 DOI: 10.1186/s13012-024-01351-1] [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: 04/27/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Given the steady decline in patient numbers at methadone maintenance treatment (MMT) clinics in Taiwan since 2013, the government initiated Patients' Medical Expenditure Supplements (PMES) in January 2019 and the MMT Clinics Accessibility Maintenance Program (MCAM) in September 2019. This study aims to evaluate the impact of the PMES and MCAM on the enrollment and retention of patients attending MMT clinics and whether there are differential impacts on MMT clinics with different capacities. METHODS The monthly average number of daily participants and 3-month retention rate from 2013 to 2019 were extracted from MMT databases and subjected to single interrupted time series analysis. Pre-PMES (from February 2013 to December 2018) was contrasted with post-PMES, either from January 2019 to December 2019 for clinics funded solely by the PMES or from January 2019 to August 2019 for clinics with additional MCAM. Pre-MCAM (from January 2019 to August 2019) was contrasted with post-MCAM (from September 2019 to December 2019). Based on the monthly average number of daily patients in 2018, each MMT clinic was categorized as tiny (1-50), small (51-100), medium (101-150), or large (151-700) for subsequent stratification analysis. RESULTS In terms of participant numbers after the PMES intervention, a level elevation and slope increase were detected in the clinics at every scale except medium in MMT clinics funded solely by PMES. In MMT clinics with subsequent MCAM, a level elevation was only detected in small-scale clinics, and a slope increase in the participant numbers was detected in tiny- and small-scale clinics. The slope decrease was also detected in medium-scale clinics. In terms of the 3-month retention rate, a post-PMES level elevation was detected at almost every scale of the clinics, and a slope decrease was detected in the overall and tiny-scale clinics for both types of clinics. CONCLUSIONS Supplementing the cost of a broad treatment repertoire enhances the enrollment of people with heroin use in MMTs. Further funding of human resources is vital for MMT clinics to keep up with the increasing numbers of participants and their retention.
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Affiliation(s)
- Yu-Chu Ella Chung
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sheng-Chang Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chieh-Liang Huang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - Lian-Yu Chen
- Department of Mental Health, Ministry of Health and Welfare, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei J Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Greer A, Xavier J, Loewen OK, Kinniburgh B, Crabtree A. Awareness and knowledge of drug decriminalization among people who use drugs in British Columbia: a multi-method pre-implementation study. BMC Public Health 2024; 24:407. [PMID: 38331771 PMCID: PMC10851533 DOI: 10.1186/s12889-024-17845-y] [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: 10/18/2023] [Accepted: 01/22/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND In January 2023, British Columbia implemented a three-year exemption to Controlled Drugs and Substances Act, as granted by the federal government of Canada, to decriminalize the personal possession of small amounts of certain illegal drugs. This decriminalization policy, the first in Canada, was announced in response to the overdose emergency in British Columbia as a public health intervention that could help curb overdose deaths by reducing the impact of criminalization and increasing access to health and social services through stigma reduction. METHODS The current multi-method study examines people who use drugs' awareness and knowledge of British Columbia's decriminalization model through cross-sectional quantitative surveys and qualitative interviews among people who use drugs from September-November 2022, immediately prior to the implementation of decriminalization. RESULTS Quantitative findings show that two-thirds (63%) of people who use drugs were aware of the policy, but substantial knowledge gaps existed about the legal protections afforded (threshold amount, substances included, drug trafficking, confiscation). The qualitative findings suggest that people who use drugs misunderstood the details of the provincial decriminalization model and often conflated it with regulation. Results suggest that information sharing about decriminalization were minimal pre-implementation, highlighting areas for knowledge dissemination about people who use drugs' rights under this policy. CONCLUSIONS Given that decriminalization in British Columbia is a new and landmark reform, and that the success of decriminalization and its benefits may be undermined by poor awareness and knowledge of it, efforts to share information, increase understanding, and empower the community, may be required to promote its implementation and benefits for the community.
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Affiliation(s)
- Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada.
| | - Jessica Xavier
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada
- British Columbia Center for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Olivia K Loewen
- Public Health Agency of Canada, Sinclair Centre Federal Building, 218-757 Hastings St. West, Vancouver, BC, V6C 1A1, Canada
| | - Brooke Kinniburgh
- British Columbia Center for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Alexis Crabtree
- British Columbia Center for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
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Hall NY, Le L, Abimanyi-Ochom J, Mihalopoulos C. Measuring the importance of different barriers to opioid agonist treatment using best-worst scaling in an Australian setting. Health Policy 2023; 138:104939. [PMID: 37949002 DOI: 10.1016/j.healthpol.2023.104939] [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: 04/28/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Opioid agonist treatment (OAT) is an effective treatment for opioid use disorder (OUD), however several client barriers to OAT are reported. Client importance of these barriers using economic preference elicitation measures have not been identified. This paper determines the most important OAT barriers using best-worst scaling (BWS) and compares the results of BWS to Likert scale. METHODS Cross-sectional self-completed survey with 191 opioid dependent clients who attended Australian needle and syringe sites. Participants were presented 15 Likert scale barriers and 15 BWS barrier scenarios. The BWS data was presented using count analysis, multinomial logit and mixed logit models. The ranking of barrier items was completed using three BWS methods and one Likert scale method, with share preference results (BWS) or mean scores (Likert) used to rank the 15 barriers. RESULTS The most important client barriers were 'enjoy using opioids', 'lack of support services' and 'hard to access'. The four ranking methods produced different barrier rankings for the most important barriers, but similar results for the least important barriers. CONCLUSION Policies around OAT as a harm reduction approach, increased support services and increased availability of OAT services would be beneficial in improving OAT uptake. Comparing BWS and Likert methods produced different highest ranked barriers, indicating the method used to identify preferences has significant implications on the type of intervention prioritised.
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Affiliation(s)
| | - Long Le
- Public Health and Preventative Medicine, Monash University, Australia
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MacKinnon L, Kerman N, Socías ME, Brar R, Bardwell G. Primary care embedded within permanent supportive housing for people who use substances: A qualitative study examining healthcare access in Vancouver, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5062-e5073. [PMID: 35852403 PMCID: PMC9970158 DOI: 10.1111/hsc.13921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/09/2022] [Accepted: 07/08/2022] [Indexed: 05/11/2023]
Abstract
Marginally housed people who use drugs and alcohol (PWUD/A) face barriers in accessing healthcare services, which may be improved by providing healthcare in housing settings. This case study examines the experiences of healthcare access amongst PWUD/A who live in a permanent supportive housing model in Vancouver, Canada. This model has an embedded multidisciplinary clinic providing in-reach services. Thirty participants were recruited via posters placed throughout the building and semi-structured qualitative interviews were conducted remotely. Interviews were conducted with participants who accessed onsite care regularly (n = 15) and those who do not (n = 15). Data were analysed to identify both a priori and emerging themes. Participants who accessed the onsite clinic reported benefiting from stigma-free care. Close proximity and convenience of drop-in appointments enabled participants to engage with healthcare services more consistently, though hours of operation and privacy concerns were barriers for others. Participants who did not use the onsite clinic highlighted the importance of continuity of care with their pre-existing primary care team, particularly if their clinic was in close geographic proximity. However, they also described utilising these services for urgent health needs or as an occasional alternative source of care. Shared perspectives across all participants emphasised the importance of low-barrier services, including medication delivery, convenience and positive therapeutic relationships. Our findings suggest that embedding access to primary care within supportive housing benefits PWUD/A who have previously encountered barriers to healthcare access. This model could be implemented to prevent utilisation of acute healthcare resources and improve health outcomes amongst PWUD/A.
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Affiliation(s)
- Laura MacKinnon
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - M. Eugenia Socías
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Rupinder Brar
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Hall N, Le L, Majmudar I, Teesson M, Mihalopoulos C. Treatment-seeking behaviour among people with opioid use disorder in the high-income countries: A systematic review and meta-analysis. PLoS One 2021; 16:e0258620. [PMID: 34653220 PMCID: PMC8519451 DOI: 10.1371/journal.pone.0258620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 09/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine treatment seeking behaviour in those with opioid use disorder (OUD) in the high-income countries. METHODS Five databases were searched in November 2019 for quantitative studies that reported OUD treatment seeking behaviour. Data analysis involved determining an overall pooled proportion estimate of treatment seeking behaviour for the two base groups, lifetime treatment and past 12-month or less treatment using the IVhet effect model. Subgroup analysis included heroin OUD, prescription OUD and general OUD. The sensitivity analysis included removal of outliers, separating adults and adolescents and the metaXL sensitivity analysis (studies are excluded if outside the pooled proportion confidence interval of the base case). Systematic review Prospero database registration number [CRD42020159531]. RESULTS There were 13 quantitative studies included in the systematic review, with all studies being from the United States of America (USA). IVhet models showed that 40% (95% CI: 23%, 58%) and 21% (95% CI: 16%, 26%) sought treatment in their lifetime and past 12 months respectively. Sub-group analysis found that lifetime treatment seeking for prescription OUD, 29% (95% CI: 27%, 31%), was less than for heroin plus combined OUD, 54% (95% CI: 26%, 82%). Most of the pooled results had high heterogeneity statistics except for results of lifetime treatment seeking for prescription OUD and past 12-month treatment seeking for prescription OUD. CONCLUSION All included studies in this meta-analysis were from the USA and indicate modest levels of treatment seeking for those with OUD. In particular, this review found that in the USA one in five people with OUD sought OUD treatment in the previous 12 months and two in five people with OUD sought OUD treatment in their lifetime. Further research is urgently required to explore the barriers and facilitators that can improve this low treatment seeking in those with OUD.
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Affiliation(s)
- Natasha Hall
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Long Le
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Ishani Majmudar
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Maree Teesson
- Director Matilda Centre for Research in Mental Health and Substance Use, Sydney University, Sydney, Australia
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Burwood, Australia
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Ndimbii J, Guise A, Igonya EK, Owiti F, Strathdee S, Rhodes T. Qualitative Analysis of Community Support to Methadone Access in Kenya. Subst Use Misuse 2021; 56:1312-1319. [PMID: 34027819 PMCID: PMC10708729 DOI: 10.1080/10826084.2021.1922450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Methadone, as part of Medically Assisted Therapy (MAT) for treatment of opioid dependence and supporting HIV prevention and treatment, has been recently introduced in Kenya. Few low income settings have implemented methadone, so there is little evidence to guide ongoing scale-up across the region. We specifically consider the role of community level access barriers and support. OBJECTIVES To inform ongoing MAT implementation we implemented a qualitative study to understand access barriers and enablers at a community level. METHODS We conducted 30 semi-structured interviews with people who use drugs accessing MAT, supplemented by interviews with 2 stakeholders, linked to participant observation in a community drop in center within one urban area in Kenya. We used thematic analysis. RESULTS We developed five themes to express experiences of factors enabling and disabling MAT access and how community support can address these: 1) time, travel and economic hardship; 2) managing methadone and contingencies of life, 3) peer support among MAT clients as treatment ambassadors, 4) family relations, and 5)outreach project contributions. Crosscutting themes address managing socioeconomic constraints and gender inequities. CONCLUSIONS People who use drugs experience and manage socio-economic constraints and gender inequities in accessing MAT with the support of local communities. We discuss how these access barriers could be addressed through strengthening the participation of networks of people who use drugs in drug treatment and supporting community projects working with people who use drugs. We also explore potential for how socio-economic constraints could be managed within an integrated health and social care response.
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Affiliation(s)
| | - Andy Guise
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Emmy Kageha Igonya
- School of Medicine, University of Nairobi, Nairobi, Kenya
- Kenya & African Population and Health Research Center, Nairobi, Kenya
| | - Frederick Owiti
- School of Medicine, University of Nairobi, Nairobi, Kenya
- Kenya & African Population and Health Research Center, Nairobi, Kenya
| | - Steffanie Strathdee
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
- University of New South Wales, Syndey, Australia
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Hall NY, Le L, Majmudar I, Mihalopoulos C. Barriers to accessing opioid substitution treatment for opioid use disorder: A systematic review from the client perspective. Drug Alcohol Depend 2021; 221:108651. [PMID: 33667783 DOI: 10.1016/j.drugalcdep.2021.108651] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To update the existing evidence to identify specific barriers to initiation of opioid substitution therapy (OST) for those with opioid use disorder (OUD). METHODS The review follows Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA) guidelines. Six databases were initially searched in November 2019, with the search updated on 11 November 2020, for qualitative or quantitative studies reporting the barriers to initiating OST from the client with OUD perspective. Thematic analysis of the barriers to OST was undertaken to determine barrier themes and subthemes. RESULTS There were 37 studies included in the review; 18 were qualitative, 15 were quantitative and four were mixed methods. The barrier themes identified were stigma and fear, regulatory, logistical, attitudinal and social factors. Within these barrier themes 19 barrier subthemes were identified. The most reported OST barrier subthemes were negative treatment perceptions, cost, stigma and lack of flexibility. CONCLUSION This review discusses important barriers to OST and examines reported barriers from the client perspective. OST guidelines and programs would benefit by introducing programs that reduce stigma, increase treatment knowledge and health literacy, reduce treatment costs, increase treatment flexibility and allow for easier treatment access.
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Affiliation(s)
- Natasha Yvonne Hall
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Long Le
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Ishani Majmudar
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Bardwell G, Strike C, Mitra S, Scheim A, Barnaby L, Altenberg J, Kerr T. "That's a double-edged sword": Exploring the integration of supervised consumption services within community health centres in Toronto, Canada. Health Place 2019; 61:102245. [PMID: 31740126 DOI: 10.1016/j.healthplace.2019.102245] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/29/2019] [Accepted: 11/08/2019] [Indexed: 01/04/2023]
Abstract
Supervised consumption services (SCS) have been integrated into community health centres in Toronto. We draw on qualitative interviews and ethnographic observations to examine the implementation contexts of these SCS. Participants' perspectives on the integration of SCS within CHCs were mixed. Some participants identified the benefits of integrated SCS such as convenience and access to other health and social services. However, others identified negative consequences of integration, including building design, lack of privacy and anonymity, and limited hours of operation. These perspectives highlight the ways in which contextual factors affect the experiences of clients in accessing SCS, and suggest that various factors need to be considered in order to improve service uptake.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Carol Strike
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Sanjana Mitra
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Ayden Scheim
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 50 Bond Street, Toronto, ON, M5B 1W8, Canada; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Lorraine Barnaby
- Parkdale Queen West Community Health Centre, 168 Bathurst Street, Toronto, ON, M5V 2R4, Canada
| | - Jason Altenberg
- South Riverdale Community Health Centre, 955 Queen Street East, Toronto, ON, M4M 3P3, Canada
| | - Thomas Kerr
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
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Zhang L, Bao J, Harrington A, Fan X, Ning Z, Zhang J, Shi D, Hu M, Zhou Z, Cai Z, Zhao M, Du J. Mixed methods to explore factors associated with the decline of patients in the methadone maintenance treatment program in Shanghai, China. Harm Reduct J 2019; 16:34. [PMID: 31133016 PMCID: PMC6537310 DOI: 10.1186/s12954-019-0304-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background This study was to characterize the Methadone Maintenance Treatment (MMT) in Shanghai, China, and to explore factors associated with the decline of patients in MMT during 2005–2016. Methods Both qualitative and quantitative methods were used in this study. Based on the data from Shanghai Centers for Disease Control (CDC), we described the changes in the number of patients who received MMT, and new enrollment each year from 2005 to 2016. Focus groups were conducted with 22 patients, and in-depth interviews were conducted with 9 service providers. Results Quantitative data demonstrate that the number of new enrollment began to decline in 2009, and the number of patients receiving MMT began to decline in 2012. The main reasons for dropout include (1) discontinuing medication due to unknown reasons (25%), (2) criminal activities other than drug-related crimes (20%), (3) relapse to heroin use (16%), and (4) physical disease (10%). Qualitative assessment results indicate that the major reasons for the decline of patients in MMT are as follows: (1) the increase of Amphetamine-type stimulants (ATS) use in recent years, (2) limited knowledge about MMT in both patients and MMT staff, (3) complicated enrollment criteria, and (4) discrimination against drug use. Conclusion Various reasons to explain the decline of patients in MMT in Shanghai, China, were identified. Government agencies, service providers, and other stakeholders need to work together and overcome identified barriers to support MMT programs in China.
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Affiliation(s)
- Lei Zhang
- Department of Substance Abuse and Addiction, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Bao
- Department of Substance Abuse and Addiction, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Amy Harrington
- Psychotic Disorders Program, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, USA
| | - Xiaoduo Fan
- Psychotic Disorders Program, UMass Memorial Medical Center/University of Massachusetts Medical School, Worcester, MA, USA
| | - Zhen Ning
- Department of Public Health, Shanghai Municipal Center for Disease Control Prevention, Shanghai, China
| | - Jingying Zhang
- Department of Substance Abuse and Addiction, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daqing Shi
- Shanghai Compulsory Drug Rehabilitation Center, Shanghai, China
| | - Manji Hu
- Department of Methadone Maintenance Treatment Clinics, Shanghai Yangpu Mental Health Center, Shanghai, China
| | - Zhirong Zhou
- Department of Methadone Maintenance Treatment Clinics, Shanghai Xuhui Mental Health Center, Shanghai, China
| | - Zhengyi Cai
- Department of Methadone Maintenance Treatment Clinics, Shanghai Pudong Mental Health Center, Shanghai, China
| | - Min Zhao
- Department of Substance Abuse and Addiction, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China. .,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Jiang Du
- Department of Substance Abuse and Addiction, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Bardwell G, Strike C, Altenberg J, Barnaby L, Kerr T. Implementation contexts and the impact of policing on access to supervised consumption services in Toronto, Canada: a qualitative comparative analysis. Harm Reduct J 2019; 16:30. [PMID: 31046759 PMCID: PMC6498561 DOI: 10.1186/s12954-019-0302-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Supervised consumption services (SCS) are being implemented across Canada in response to a variety of drug-related harms. We explored the implementation context of newly established SCS in Toronto and the role of policing in shaping program access by people who inject drugs (PWID). METHODS We conducted one-to-one qualitative semi-structured interviews with 24 PWID. Participants were purposively recruited. Ethnographic observations were conducted at each of the study sites as well as in their respective neighbourhoods. Relevant policy documents were also reviewed. RESULTS Policing was overwhelmingly discussed by participants from both SCS sites. However, participant responses varied depending on the site in question. Subthemes from participant responses on policing at site #1 described neighbourhood police presence and fears of police harassment and drug arrests before, during, or after accessing SCS. Conversely, subthemes from participant responses on policing at site #2 described immunity and protection from police while using the SCS, as well as a lack of police presence or fears of police harassment and arrests. These differences in implementation contexts were largely shaped by differences in local neighbourhoods and drug scenes. Police policies highlighted federal laws protecting PWID within SCS, but also the exercise of discretion when applying the rule of law outside of these settings. CONCLUSIONS Participants' perspectives on, and experiences with, policing as they relate to accessing SCS were shaped by the implementation contexts of each SCS site and how neighbourhoods, drug scenes, and differences in policing practices affected service use. Our findings also demonstrate the disconnect between the goals of policing and those of SCS. Until larger structural barriers are addressed (e.g. criminalization), future SCS programming should consider the impact of policing on the SCS implementation context to improve client experience with, and access to, SCS.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Carol Strike
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3 M7, Canada
| | - Jason Altenberg
- South Riverdale Community Health Centre, 955 Queen Street East, Toronto, ON, M4M 3P3, Canada
| | - Lorraine Barnaby
- Parkdale Queen West Community Health Centre, 168 Bathurst Street, Toronto, ON, M5V 2R4, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
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DeBeck K, Cheng T, Montaner JS, Beyrer C, Elliott R, Sherman S, Wood E, Baral S. HIV and the criminalisation of drug use among people who inject drugs: a systematic review. Lancet HIV 2017; 4:e357-e374. [PMID: 28515014 PMCID: PMC6005363 DOI: 10.1016/s2352-3018(17)30073-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mounting evidence suggests that laws and policies prohibiting illegal drug use could have a central role in shaping health outcomes among people who inject drugs (PWID). To date, no systematic review has characterised the influence of laws and legal frameworks prohibiting drug use on HIV prevention and treatment. METHODS Consistent with PRISMA guidelines, we did a systematic review of peer-reviewed scientific evidence describing the association between criminalisation of drug use and HIV prevention and treatment-related outcomes among PWID. We searched MEDLINE, Embase, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL, Web of Science, and other sources. To be included in our review, a study had to meet the following eligibility criteria: be published in a peer-reviewed journal or presented as a peer-reviewed abstract at a scientific conference; examine, through any study design, the association between an a-priori set of indicators related to the criminalisation of drugs and HIV prevention or treatment among PWID; provide sufficient details on the methods followed to allow critical assessment of quality; be published or presented between Jan 1, 2006, and Dec 31, 2014; and be published in the English language. FINDINGS We identified 106 eligible studies comprising 29 longitudinal, 49 cross-sectional, 22 qualitative, two mixed methods, four mathematical modelling studies, and no randomised controlled trials. 120 criminalisation indicators were identified (range 1-3 per study) and 150 HIV indicators were identified (1-5 per study). The most common criminalisation indicators were incarceration (n=38) and street-level policing (n=39), while the most frequent HIV prevention and treatment indicators were syringe sharing (n=35) and prevalence of HIV infection among PWID (n=28). Among the 106 studies included in this review, 85 (80%) suggested that drug criminalisation has a negative effect on HIV prevention and treatment, 10 (9%) suggested no association, five (5%) suggested a beneficial effect, one (1%) suggested both beneficial and negative effects, and five (5%) suggested both null and negative effects. INTERPRETATION These data confirm that criminalisation of drug use has a negative effect on HIV prevention and treatment. Our results provide an objective evidence base to support numerous international policy initiatives to reform legal and policy frameworks criminalising drug use. FUNDING Canadian Institutes of Health Research and US National Institutes of Health.
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Affiliation(s)
- Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Tessa Cheng
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Julio S Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Beyrer
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Susan Sherman
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stefan Baral
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA.
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12
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Zhang B, Cai T, Yan Z, Mburu G, Wang B, Yang L. Impact of blended treatment literacy and psychoeducation on methadone maintenance treatment outcomes in Yunnan, China. Harm Reduct J 2016; 13:8. [PMID: 26915361 PMCID: PMC4768342 DOI: 10.1186/s12954-016-0097-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/18/2016] [Indexed: 02/08/2023] Open
Abstract
Background Outcomes of methadone maintenance treatment (MMT) in the management of opioid dependency can be impaired by poor adherence and retention, concomitant drug use, poor adjustment of methadone dosage, and low levels of awareness regarding methadone among drug users, among other factors. This study investigated the effects of intensive blended treatment literacy and psychoeducation on treatment compliance, methadone dose, and heroin use among MMT clients in China. Methods A total of 492 MMT clients who tested positive for urine morphine at least once during a 12-week intervention period preceding the study were recruited from 16 MMT clinics. Employing a client-centred approach, a blended treatment literacy and psychoeducation intervention was then implemented between March and June 2014, comprising (1) intensified methadone treatment literacy sessions; (2) participatory goal setting; (3) continuous adherence monitoring and support; and (4) engagement of both peers and doctors in delivering psychoeducation. Wilcoxon signed-rank test was used to compare urine morphine positive rates, daily methadone dosage, and the number of days that clients successfully accessed methadone before and during the intervention. Results During the intervention, urine morphine positive rates reduced to 27 % from 49.3 % previously; p < 0.001. In response to client needs, methadone dosages increased among 74 % of participants, remained unchanged among 12.0 %, and reduced among 13.4 % during the intervention. In addition, the average daily methadone dose increased from 63.0 to 72.6 mg; p < 0.001, while the average number of days that clients successfully accessed methadone increased from 69.4 to 73.9 over a period of 12 weeks; p < 0.001. Conclusions Blended treatment literacy and psychoeducation delivered by a combination of peers and doctors was associated with reduced heroin use, improved treatment adherence, and higher methadone doses among our sample of MMT clients.
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Affiliation(s)
- Bo Zhang
- Yunnan Institute of Drug Abuse (YIDA), 300 Wujiadui, Xihuayuan, Xishan District, Kunming, Yunnan, China.
| | - Thomas Cai
- AIDS Care China, R 201, #17 Rongyuan, Jinjiang Residential Quarter, Bejing Road, Panlong District, Kunming, Yunnan, China.
| | - Zhihua Yan
- AIDS Care China, R 201, #17 Rongyuan, Jinjiang Residential Quarter, Bejing Road, Panlong District, Kunming, Yunnan, China.
| | - Gitau Mburu
- International HIV/AIDS Alliance, 91-101 Davigdor Road, Hove, BN3 1RE, UK. .,Department of Health Research, Lancaster University, Lancaster, LA1 4YW, UK.
| | - Bangyuan Wang
- International HIV/AIDS Alliance, 91-101 Davigdor Road, Hove, BN3 1RE, UK.
| | - Liping Yang
- Yunnan Institute of Drug Abuse (YIDA), 300 Wujiadui, Xihuayuan, Xishan District, Kunming, Yunnan, China.
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Investigation of Repeat Client Drop-Out and Re-Enrolment Cycles in Fourteen Methadone Maintenance Treatment Clinics in Guangdong, China. PLoS One 2015; 10:e0139942. [PMID: 26484772 PMCID: PMC4618733 DOI: 10.1371/journal.pone.0139942] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/18/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Client adherence is vital for effective methadone maintenance treatment (MMT). This study explores the pattern and associated factors of client adherence, drop-out and re-enrolment in the Chinese MMT programme over the period of 2006-2013. METHODS This retrospective study was conducted in 14 MMT clinics in Guangdong Province, China. We employed Kaplan-Meier survival analysis to estimate the rates of drop-out and re-enrolment of MMT clients and multivariate Cox regression to identify associated factors. RESULTS Among 1,512 study participants, 79% have experienced 'drop-out' during the 7-year study period. However, 82% 'dropped-out' clients resumed treatment at a later time. Low education level (junior high or below versus otherwise, HR = 1.21, 1.05-1.40), low methadone dosage in the first treatment episode (<50 ml versus ≥50 ml, HR = 1.84, 1.64-2.06) and higher proportion of positive urine test (≥50% versus<50%, HR = 3.72, 3.30-4.20) during the first treatment episode were strong predictors of subsequent drop-outs of the participants. Among the 'dropped-out' clients, being female (HR = 1.40, 1.23-1.60), being married (HR = 1.19, 1.09-1.30), and having a higher proportion of positive urine tests in the first treatment episode (≥50% versus<50%, HR = 1.35, 1.20-1.51) had greater likelihood of subsequent re-enrolment in MMT. Clients receiving lower methadone dosage (first treatment episode <50 ml versus ≥50 ml, HR = 1.12, 1.03-1.23; the last intake before drop-out <50 ml versus ≥50 ml, HR = 1.16, 1.04-1.30) were also more likely to re-enrol. CONCLUSION Persistent cycling in-and-out of clients in MMT programmes is common. Insufficient dosage and higher proportion of positive urine samples in the first treatment episode are the key determinants for subsequent client drop-out and re-enrolment. Interventions should target clients in their early stage of treatment to improve retention in the long term.
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Koo FK, Chen X, Chow EPF, Jing J, Zheng J, Zhao J, Zhang L. Barriers and Potential Improvements for Needle and Syringe Exchange Programs (NSPs) in China: A Qualitative Study from Perspectives of Both Health and Public Security Sectors. PLoS One 2015; 10:e0130654. [PMID: 26114556 PMCID: PMC4482722 DOI: 10.1371/journal.pone.0130654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 05/25/2015] [Indexed: 11/18/2022] Open
Abstract
This study explores the acceptability, the barriers to the implementation of needle and syringe exchange programs (NSPs) and the potential improvement strategies in China from the perspectives of governmental health and public security officials. Purposive sampling was used for recruitment of participants who had been involved in NSPs implementation. Semi-Structured individual interviews were conducted in Mandarin to address three aspects of NSPs: (1) participants’ attitudes towards NSPs, (2) participants’ opinions on the effectiveness and barriers of NSPs, and (3) suggestions for improving the program. Content analysis was used to analyse the translated interview data. A total of 68 participants from 12 Hunan counties were interviewed (34 from each of the Bureau of Health and the Narcotic Division). Both groups recognised the importance and effectiveness of NSPs in HIV prevention, but public security officials regarded NSPs as a temporary intervention in place of punitive measures. Most health officials (32/34) regarded the main barriers to its implementation as administrative and structural, whereas participants from Narcotics Division (n=24) questioned the legitimacy of NSPs and concerned about the poor management of drug users’ risk behaviours. Close cooperation between the health and public security sectors, engagement of the drug user community and an enabling policy environment were reportedly to be critical for potential improvements of NSPs in China. Misconceptions about NSPs encourage drug users’ addictive behaviour, and an unclear leadership and insufficient support de-motivate the participants from the Bureau of Health and the Narcotics Division to actively support the program implementation.
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Affiliation(s)
- Fung Kuen Koo
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
| | - Xi Chen
- Hunan Provincial Centers for Disease Control and Prevention, Hunan, China
| | - Eric P. F. Chow
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Jun Jing
- Research Center for Public Health, Tsinghua University, Beijing, China
- * E-mail: (LZ); (JJ)
| | - Jun Zheng
- Hunan Provincial Centers for Disease Control and Prevention, Hunan, China
| | - Junshi Zhao
- Hunan Provincial Centers for Disease Control and Prevention, Hunan, China
| | - Lei Zhang
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Research Center for Public Health, Tsinghua University, Beijing, China
- * E-mail: (LZ); (JJ)
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15
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Moradi G, Farnia M, Shokoohi M, Shahbazi M, Moazen B, Rahmani K. Methadone maintenance treatment program in prisons from the perspective of medical and non-medical prison staff: a qualitative study in Iran. Int J Health Policy Manag 2015; 4:583-9. [PMID: 26340487 DOI: 10.15171/ijhpm.2015.60] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/07/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND As one of the most important components of harm reduction strategy for high-risk groups, following the HIV epidemics, Methadone Maintenance Treatment (MMT) has been initiated in prisoners since 2003. In this paper, we aimed to assess the advantages and shortcomings of the MMT program from the perspective of people who were involved with the delivery of prison healthcare in Iran. METHODS On the basis of grounded theory and through conducting 14 Focus Group Discussions (FGDs), 7 FGDs among physicians, consultants, experts, and 7 FGDs among directors and managers of prisons (n= 140) have been performed. The respondents were asked about positive and negative elements of the MMT program in Iranian prisons. RESULTS This study included a total of 48 themes, of which 22 themes were related to advantages and the other 26 were about shortcomings of MMT programs in the prisons. According to participants' views "reduction of illegal drug use and high-risk injection", "reduction of potentially high-risk behaviors" and "making positive attitudes" were the main advantages of MMT in prisons, while issues such as "inaccurate implementation", "lack of skilled manpower" and "poor care after release from prison" were among the main shortcomings of MMT program. CONCLUSION MMT program in Iran's prisons has achieved remarkable success in the field of harm reduction, but to obtain much more significant results, its shortcomings and weaknesses must be also taken into account by policy-makers.
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Affiliation(s)
- Ghobad Moradi
- Kurdistan Research Center for Social Determinants of Health (KRCSDH), Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Marzieh Farnia
- Iran Prisons Organization, Health and Treatment Department, Tehran, Iran
| | - Mostafa Shokoohi
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shahbazi
- GFATM Projects in Prisons, United Nations Development Program, Tehran, Iran
| | - Babak Moazen
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Khaled Rahmani
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Opioid pharmacotherapy: Treatment, regimes, constructions and control. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:e1-5. [DOI: 10.1016/j.drugpo.2013.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/24/2013] [Accepted: 08/10/2013] [Indexed: 11/19/2022]
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17
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Meng J, Burris S. The role of the Chinese police in methadone maintenance therapy: A literature review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:e25-34. [DOI: 10.1016/j.drugpo.2013.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 03/01/2013] [Accepted: 03/18/2013] [Indexed: 11/29/2022]
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Zhang L, Chow EPF, Zhuang X, Liang Y, Wang Y, Tang C, Ling L, Tucker JD, Wilson DP. Methadone maintenance treatment participant retention and behavioural effectiveness in China: a systematic review and meta-analysis. PLoS One 2013; 8:e68906. [PMID: 23922668 PMCID: PMC3724877 DOI: 10.1371/journal.pone.0068906] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Methadone maintenance treatment (MMT) has been scaled up by the Chinese government alongside persistent compulsory drug user detention, but the extent to which detention interferes with MMT is unknown. The study systematically reviews Chinese MMT retention rates, reasons for drop out, and behavioural changes. METHOD Chinese and English databases of literature are searched for studies reporting retention rates, drug use and sexual behaviours among MMT participants in China between 2004 and 2013. The estimates are summarized through a systematic review and meta-analysis. RESULTS A total of 74 studies representing 43,263 individuals are included in this analysis. About a third of MMT participants drop out during the first three months of treatment (retention rate 69.0% (95% CI 57.7-78.4%)). Police arrest and detention in compulsory rehabilitation was the most common cause of drop out, accounting for 22.2% of all those not retained. Among retained participants, changing unsafe drug use behaviours was more effective than changing unsafe sexual behaviours. At 12 months following MMT initiation, 24.6% (15.7-33.5%) of MMT participants had a positive urine test, 9.3% (4.7-17.8%) injected drugs and only 1.1% (0.4-3.0%) sold sex for drugs. These correspond to 0.002 (<0.001-0.011), 0.045 (0.004-0.114) and 0.209 (0.076-0.580) times lower odds than baseline. However, MMT participants did not have substantial changes in condom use rates. CONCLUSION MMT is effective in drug users in China but participant retention is poor, substantially related to compulsory detention. Reforming the compulsory drug user detention system may improve MMT retention and effectiveness.
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Affiliation(s)
- Lei Zhang
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Eric P. F. Chow
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Xun Zhuang
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Yanxian Liang
- School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Yafei Wang
- School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Caiyun Tang
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Joseph D. Tucker
- UNC Project-China, Guangzhou, Guangdong, China
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David P. Wilson
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Wu F, Peng CY, Jiang H, Zhang R, Zhao M, Li J, Hser YI. Methadone maintenance treatment in China: perceived challenges from the perspectives of service providers and patients. J Public Health (Oxf) 2012; 35:206-12. [PMID: 22997278 DOI: 10.1093/pubmed/fds079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND China has recently adopted methadone maintenance treatment (MMT) as a national strategy to address the problem of drug abuse and related public health issues such as HIV and HCV infections. However, low enrollment and retention rates suggest that barriers may exist in MMT utilization. This study examined both patients' perceptions and service providers' perceptions of challenges in MMT implementation in China. METHODS Four focus groups were conducted in two Chinese cities, Shanghai and Kunming, to explore the perceived and experienced barriers in MMT participation in China. All focus group discussions with participants were audio taped and transcribed. Atlas.ti 5.1 was used to analyze data. RESULTS Service providers and patient participants reported positive experiences (e.g. effects of MMT in curbing withdrawal symptoms) but also expressed concerns about side effects and continued heroin use during MMT. They also identified barriers in participating and remaining in MMT, including affordability (fee requirement), acceptability (methadone as a substitution, dose, long-term nature), accommodation and accessibility (inconvenient operation hours, lack of transferability to other MMT clinics during travel) and competition between public health and public security. CONCLUSIONS The present findings have implications for reconsidering the current MMT policies and practices in order to improve access, utilization and, ultimately, the effectiveness of MMT in China.
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Affiliation(s)
- Fei Wu
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd, Suite 200, University of California, Los Angeles, CA 90025, USA.
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