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"Here Comes the Junkies," Opioid Replacement Therapy in Rural Australia. J Addict Nurs 2021; 32:E1-E10. [PMID: 33646723 DOI: 10.1097/jan.0000000000000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Opioid replacement therapy (ORT) offers a harm minimization approach and is the mainstay treatment option for opioid dependence in Australia. Recovery is known to be complicated because of service access, cost, workforce availability, privacy, stigma, and discrimination. Rural living is considered to magnify each complication of recovery, yet little is understood about how opioid dependence recovery is experienced in rural Australia. This study aimed to explore the lived experience of people receiving ORT in rural Australia and describe impediments to recovery. METHODS In this qualitative study design, all outpatients enrolled in ORT at two rural Australian sites were invited to participate. Six volunteers from each site participated in a semistructured interview (eight men, four women; mean age = 44.8 years). RESULTS The participants had completed 3 years of secondary school education on average. Four major themes emerged: reinvention, restriction, employment, and reconnection. Small communities increased the likelihood of ORT participants knowing people both directly and indirectly, affecting their ability to reconstruct an identity. Lived distance from prescribers and dosing points dictated daily activity, including opportunities to seek and maintain employment. Rural ORT treatment seekers indicated that geographical displacement and separation from family, the people they needed to reconnect with, were challenging. CONCLUSION Rural people engaged in ORT require positive reinforcement from service providers, enabling identity reinvention and disconnection from the drug-seeking world. Acknowledging underlying trauma and supporting reconnection with loved ones may foster positive social connectedness.
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Yao T, Wu Y, Dong S, Gao L, Shi S, Shao Z, Wu L, Feng D, Shi J, Zhang Y, Feng Y, Liang X, Wang S. Long-term durability of immunogenicity induced by standard and triple-dose hepatitis B vaccine in patients receiving methadone maintenance treatment. Expert Rev Vaccines 2020; 19:785-794. [PMID: 32815759 DOI: 10.1080/14760584.2020.1813577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We explored the long-term immunogenicity induced by 60 μg and 20 μg hepatitis B vaccines among patients receiving methadone maintenance treatment (MMT). METHODS In initial study, a randomized controlled trial was conducted, in which patients receiving MMT were administered 20 µg (IM20 group) or 60 µg (IM60 group) hepatitis B vaccines at months 0, 1, and 6. In this study, the responders at month 7 were followed-up at months 18, 30, and 42 to estimate long-term immunogenicity. RESULTS The response rate decreased from 78.0% (39/50) to 31.1% (14/45) in the IM20 group, and from 86.0% (43/50) to 50.0% (20/40) in the IM60 group from month 7 to 42. Vaccine-induced responses in 75% of patients were observed for 14.2 months in the IM20 group and for 20.0 months in the IM60 group, and differences between these two groups were non-significant (P > 0.05). CONCLUSION The three-dose 20 µg and 60 µg hepatitis B vaccines showed similar rapid hepatitis B surface antibody decreases. Abbreviations: HBV, hepatitis B virus; MMT, methadone maintenance treatment; HCC, hepatocellular carcinoma; HBsAg, hepatitis B surface antigen; anti-HBs, hepatitis B surface antibody; HR, hazard ratio; CI, confidence interval; IQR, interquartile range; GEE, generalized estimated equation.
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Affiliation(s)
- Tian Yao
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
| | - Yuanting Wu
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
| | - Shuang Dong
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
| | - Linying Gao
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
| | - Shan Shi
- Methadone Maintenance Treatment Clinic, Nanning Red Cross Hospital , Nanning, Guangxi, PR China
| | - Zhihong Shao
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
| | - Lina Wu
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
| | - Dan Feng
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
| | - Jing Shi
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
| | - Yawei Zhang
- Yale School of Public Health , New Haven, CT, USA
| | - Yongliang Feng
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
| | - Xiaofeng Liang
- Chinese Preventive Medicine Association , Beijing, PR China
| | - Suping Wang
- School of Public Health, Shanxi Medical University , Taiyuan, Shanxi, PR China
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Yang S, Gao B, Gu J, Gong Y, Yu B, Han J, Dong P, Jia P, Yang S. Relationship between social capital and heroin use behaviors among patients in methadone maintenance treatment in Sichuan Province, China: A cross-sectional study. Medicine (Baltimore) 2020; 99:e19963. [PMID: 32541447 PMCID: PMC7302679 DOI: 10.1097/md.0000000000019963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Covertly using heroin during methadone maintenance treatment (MMT) is very common among heroin-dependent patients, which has posed threats to the physical health of heroin-dependent patients and social safety. Covertly using heroin may be influenced by many factors, especially social capital. Therefore, we aimed to investigate the relationship between behaviors of covertly using heroin during MMT and social capital heroin-dependent patients in Sichuan Province, China. A cross-sectional study was conducted between October and November 2018, with a total of 581 heroin-dependent patients participating in the study. In addition to socio-demographic characteristics and heroin use related behaviors, the questionnaire also included the measures of social capital: social network (SN), social support (SP), community participation (CP) and social trust (ST). Multivariate logistic regression analyses were used to estimate the association between different measures of social capital and heroin use. The prevalence of covertly using heroin of heroin during MMT was 31.0% among our participants in the 6 months before the study. After adjusting for socio-demographic factors and heroin-use related variables, SN (OR = 0.85, 95% CI: 0.76-0.95), SP (OR = 0.89, 95% CI: 0.83-0.95), and ST (OR = 0.88, 95% CI: 0.81-0.95) were significantly associated with heroin use. Results suggest that social capital may have a protective effect on behavior of covertly using heroin during MMT, which should be consider in the interventions for heroin-dependent patients, in order to reduce the incidence of heroin use during MMT as well as improve the compliance of MMT.
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Affiliation(s)
- Shifan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Bo Gao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou
| | - Yi Gong
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Bin Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jiayu Han
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peijie Dong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peng Jia
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
- Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
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Bidirectional relationships between retention and health-related quality of life in Chinese mainland patients receiving methadone maintenance treatment. PLoS One 2017; 12:e0179009. [PMID: 28586356 PMCID: PMC5460896 DOI: 10.1371/journal.pone.0179009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/23/2017] [Indexed: 01/04/2023] Open
Abstract
This study aimed to explore the bidirectional relationships between retention and health-related quality of life (HRQoL) in patients from mainland China receiving methadone maintenance treatment (MMT). This prospective cohort study recruited 1,212 eligible MMT patients from the two largest MMT clinics (one privately and another publicly funded) in Xi'an. This study started in March 2012 with a 2-year follow-up until March 2014. Retention was assessed by repeated terminations, past treatment duration, premature terminations, and follow-up treatment duration. HRQoL was evaluated using the Chinese (simple) short-form 36 health survey version 2 (SF-36v2) and the quality of life scale for drug addicts (QOL-DAv2.0). Linear and Cox regression analyses were used to explore relationships between retention and HRQoL. A general linear model was used to further examine the global effect of past treatment duration on HRQoL. Multivariate analyses showed that repeated terminations had no significant impact on HRQoL scores in MMT patients; however, past treatment time (year) influenced the SF-36v2PCS (P = 0.004): treatment for ≥4 years showed a lower SF-36v2PCS score (regression coefficient: -2.39; 95% confidence interval [CI]: -3.80, -0.97; P = 0.001) than treatment for <1 year. In addition, patients with an SF-36v2PCS score > 49 (hazard ratio: 0.83; 95% CI: 0.69, 0.98; P = 0.03) were 17% less likely to terminate MMT than those with scores of ≤49. In conclusion, retention and HRQoL tended to have a bidirectional relationship, which should be considered in the development of retention and health-management programs for patients with MMT.
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Luo X, Gong X, Zhao P, Zou X, Chen W, Ling L. Positive percentages of urine morphine tests among methadone maintenance treatment clients with HIV/AIDS: a 12-month follow-up study in Guangdong Province, China. BMJ Open 2017; 7:e014237. [PMID: 28450464 PMCID: PMC5566940 DOI: 10.1136/bmjopen-2016-014237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
- Xiaofeng Luo
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen Center for Migrant Health Policy, Sun Yat-Sen University, Guangzhou, China
| | - Xiao Gong
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen Center for Migrant Health Policy, Sun Yat-Sen University, Guangzhou, China
| | - Peizhen Zhao
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, China
| | - Xia Zou
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen Center for Migrant Health Policy, Sun Yat-Sen University, Guangzhou, China
| | - Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen Center for Migrant Health Policy, Sun Yat-Sen University, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen Center for Migrant Health Policy, Sun Yat-Sen University, Guangzhou, China
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Erectile Dysfunction Among Patients on Methadone Maintenance Therapy and Its Association With Quality of Life. J Addict Med 2017; 11:40-46. [DOI: 10.1097/adm.0000000000000267] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Having a stable and safe place to live is integral to recovery from addiction. Recovery residences represent an important component in the substance use continuum of care, but research on them has been limited to certain types of recovery residences and has yet to examine quality of life among those who live in them. METHODS This study presents data on the characteristics of residents (N = 104) living in a stratified random sample of recovery homes in Philadelphia (N = 13) as well as data from a random subsample of residents (N = 27) who participated in 3-month follow-up interviews. RESULTS Residents in these homes reported deficits in a variety of aspects of their lives critical to helping them initiate and sustain their recovery; many (20%) reported living in a shelter or on the streets prior to moving in, 37% had less than a high school education, and only 26% reported currently working for pay. Although the majority of residents rated their quality of life as good or very good (74%), average physical health, social relationship, and environment domain scores measured by the World Health Organization Quality of Life (WHOQOL)-Bref were generally lower than scores found among community samples. At follow-up, all residents were housed and rates of substance use (7%), criminal justice involvement (0%), and employment (44%) in the past 30 days were encouraging. Quality of life domain scores were unchanged, with the exception of psychological health, which decreased. CONCLUSIONS These findings highlight the complex needs of residents living in Philadelphia recovery homes and the role that these homes play in maintaining residents in their early recovery. Studies with larger samples of residents followed up over longer periods of time are needed to assess the role that these homes may play in promoting long-term recovery and improving the well-being of the vulnerable population of individuals who live in them.
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Affiliation(s)
- Amy A Mericle
- a Alcohol Research Group , Public Health Institute , Emeryville , California , USA
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Teoh Bing Fei J, Yee A, Habil MHB, Danaee M. Effectiveness of Methadone Maintenance Therapy and Improvement in Quality of Life Following a Decade of Implementation. J Subst Abuse Treat 2016; 69:50-6. [PMID: 27568510 DOI: 10.1016/j.jsat.2016.07.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/24/2016] [Accepted: 07/13/2016] [Indexed: 11/18/2022]
Abstract
Methadone maintenance therapy has been found to be an effective harm reduction treatment for opioid use disorder. However evidence of its benefits over a longer duration of treatment is limited as most studies focus on its short term benefits. As methadone maintenance therapy reaches a decade since its implementation in Malaysia, this study sought to examine the effectiveness of methadone treatment, change in quality of life among patients since entry to methadone treatment, as well as factors predicting the magnitude of change in quality of life. This study found that methadone maintenance therapy was effective in reducing heroin use, injecting practices and crime, and in improving in social functioning and physical symptoms, but not in reducing sex-related HIV risk-taking behavior. Though patients had a significantly better quality of life at follow-up than at entry to methadone maintenance therapy, the improvement in quality of life was not significantly greater as the duration of treatment increased. Age above 50 years old, human immunodeficiency virus (HIV) positive status and physical symptoms predicted a poorer improvement in quality of life between baseline and follow-up. On the other hand, patients with hepatitis B showed a greater improvement in quality of life in the social relationships domain compared to patients without hepatitis B. In conclusion, methadone maintenance therapy is an effective treatment for opioid use disorder and improves quality of life but its benefits in further improving quality of life beyond a decade of treatment need further evaluation.
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Affiliation(s)
- Joni Teoh Bing Fei
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Anne Yee
- University Malaya Centre for Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Mahmoud Danaee
- Unit for the Enhancement of Academic Performance, University of Malaya, Kuala Lumpur, Malaysia
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Gutwinski S, Schoofs N, Stuke H, Riemer TG, Wiers CE, Bermpohl F. Opioid tolerance in methadone maintenance treatment: comparison of methadone and levomethadone in long-term treatment. Harm Reduct J 2016; 13:7. [PMID: 26879120 PMCID: PMC4754801 DOI: 10.1186/s12954-016-0095-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/04/2016] [Indexed: 12/05/2022] Open
Abstract
Background This study aimed to investigate the development of opioid tolerance in patients receiving long-term methadone maintenance treatment (MMT). Methods A region-wide cross-sectional study was performed focusing on dosage and duration of treatment. Differences between racemic methadone and levomethadone were examined. All 20 psychiatric hospitals and all 110 outpatient clinics in Berlin licensed to offer MMT were approached in order to reach patients under MMT fulfilling the DSM IV criteria of opiate dependence. In the study, 720 patients treated with racemic methadone or levomethadone gave information on the dosage of treatment. Out of these, 679 patients indicated the duration of MMT. Results Treatment with racemic methadone was reported for 370 patients (54.5 %), with levomethadone for 309 patients (45.5 %). Mean duration of MMT was 7.5 years. We found a significant correlation between dosage and duration of treatment, both in a conjoint analysis for the two substances racemic methadone and levomethadone and for each substance separately. These effects remained significant when only patients receiving MMT for 1 year or longer were considered, indicating proceeding tolerance development in long-term treatment. When correlations were compared between racemic methadone and levomethadone, no significant difference was found. Conclusions Our data show a tolerance development under long-term treatment with both racemic methadone and levomethadone. Tolerance development did not differ significantly between the two substances.
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Affiliation(s)
- Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Nikola Schoofs
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Heiner Stuke
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Thomas G Riemer
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Corinde E Wiers
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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