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

Non-adherence to treatment and concurrent opioid use among people on methadone maintenance treatment using methamphetamine in Vietnam

INTRODUCTION

The global rise of concurrent use of opioids and methamphetamine presents challenges to stable methadone maintenance treatment (MMT). We assessed non-adherence to treatment and concurrent opioid use, along with associated factors, among people on MMT using methamphetamine in Vietnam.

METHODS

This analysis utilized baseline data from a randomized clinical trial designed to investigate the effectiveness of various combinations of behavioral evidence-based interventions for methamphetamine use among patients on MMT in Vietnam (STAR-OM R01DA050486). We used data from 498 participants on MMT who self-reported using methamphetamine in the past 30 days and had been in MMT treatment for at least three months. The study determined adherence to MMT through medical record review and assessed concurrent opioid use via urine testing and documented test results in medical records.

RESULTS

Within the last three months, 145 (29.1 %) did not adhere to MMT, and 212 (42.6 %) concurrently used opioids. Non-adherence to MMT were strongly associated with living at a considerable distance from the clinic (aOR = 1.80, 95 % CI: 1.10-2.90), being HIV positive (aOR = 0.51, 95 % CI: 0.27-0.97), and were marginally associated with using methamphetamine to reduce emotional distress (aOR = 1.56, 95 % CI: 0.99-2.45). Concurrent opioid use was associated with receiving treatment at clinics established during the scale-up period (aOR = 1.80, 95 % CI: 1.13-2.87), an extended duration of treatment at current clinics (aOR = 0.98, 95 % CI: 0.97-0.99), male gender (aOR = 2.09, 95 % CI: 1.05-4.13), and ever injecting methamphetamine (aOR = 1.98, 95 % CI: 1.13-3.46), besides MMT non-adherence (aOR = 2.71, 95 % CI: 1.72-4.29).

CONCLUSION

Non-adherence to MMT and concurrent opioid use are prevalent among methamphetamine-using patients on methadone in Vietnam. Alongside well-documented factors influencing methadone program, the rise in methamphetamine adds further complexity to these challenges. Future intervention strategies must address both the underlying issues and methamphetamine use behaviors to effectively improve treatment outcomes.

TRIAL REGISTRATION

NCT04706624. Registered 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.

Opioidergic tuning of social attachment: reciprocal relationship between social deprivation and opioid abuse

Individuals misusing opioids often report heightened feelings of loneliness and decreased ability to maintain social connections. This disruption in social functioning further promotes addiction, creating a cycle in which increasing isolation drives drug use. Social factors also appear to impact susceptibility and progression of opioid dependence. In particular, increasing evidence suggests that poor early social bond formation and social environments may increase the risk of opioid abuse later in life. The brain opioid theory of social attachment suggests that endogenous opioids are key to forming and sustaining social bonds. Growing literature describes the opioid system as a powerful modulator of social separation distress and attachment formation in rodents and primates. In this framework, disruptions in opioidergic signaling due to opioid abuse may mediate social reward processing and behavior. While changes in endogenous opioid peptides and receptors have been reported in these early-life adversity models, the underlying mechanisms remain poorly understood. This review addresses the apparent bidirectional causal relationship between social deprivation and opioid addiction susceptibility, investigating the role of opioid transmission in attachment bond formation and prosocial behavior. We propose that early social deprivation disrupts the neurobiological substrates associated with opioid transmission, leading to deficits in social attachment and reinforcing addictive behaviors. By examining the literature, we discuss potential overlapping neural pathways between social isolation and opioid addiction, focusing on major reward-aversion substrates known to respond to opioids.

Social support status and associated factors among methadone maintenance patients: a multicentre, cross-sectional study in Vietnam during the COVID-19 pandemic

OBJECTIVES

To investigate the social support status and associated factors among Vietnamese methadone maintenance patients during the COVID-19 pandemic.

DESIGN

Cross-sectional study.

SETTING

Three methadone clinics.

PARTICIPANTS

540 patients.

PRIMARY AND SECONDARY OUTCOME MEASURES

The Medical Outcomes Study-Social Support Survey questionnaire was employed to measure patients' social support. Factors associated with the social support status of patients were determined through multivariate linear regression models. Variables in these models were selected using the Bayesian model averaging method.

RESULTS

The average social support score of patients was 63.50±26.54 (ranger: 0-100). The average social support scores of patients living in mountainous areas (Dien Bien: 63.74±23.67, Son La: 46.15±20.31) were significantly lower than that of patients residing in metropolitan areas (Hanoi: 80.61±23.47) (p<0.001). The likelihood of gaining high social support was 1.31 times more likely among patients living with at least one person (64.21±26.25) in comparison with those living alone (48.84±28.69) (p=0.013). The higher the number of family members living with the patient and close friends/relatives, the higher the social support score. Factors significantly associated with patients' social support included the place of residence, the patient's occupation, the family's monthly income, the number of people living with the patients, and the number of close friends/relatives (p<0.001).

CONCLUSION

Methadone maintenance patients in Vietnam received a moderate level of social support during the COVID-19 pandemic. In the context of pandemics, not only the authorities but also family members and the community should give succour and strength to the patients, thereby contributing to the success of methadone treatment and the recovery of patients.

Treatment non-adherence among methadone maintenance patients and associated factors: a multicenter, cross-sectional study in Vietnam

OBJECTIVE

This multicenter, cross-sectional study was conducted to investigate the prevalence of treatment non-adherence and its associated factors among methadone maintenance patients in Vietnam.

METHODS

This secondary data analysis was conducted using the data from a previous study. Six hundred patients were interviewed face-to-face to collect data on their demographic characteristics and social support. Information about the treatment characteristics and patients' non-adherence was gathered from medical records and books monitoring their treatment process. Treatment non-adherence was defined as missing at least one methadone dose in the last three months.

RESULTS

The overall prevalence of non-adherence was 45.7%. The average social support score of patients who completely adhered to treatment was significantly higher than that of those who did not (p < 0.001). In the multivariate logistic regression model, for each one-unit increase in social support (one score), treatment time (a year), and patient's monthly income (one million Vietnam dongs), the odds of non-adherence decreased by 28% (aOR = 0.72, 95%CI 0.59-0.88, p = 0.002), 15% (aOR = 0.85, 95%CI 0.80-0.91, p < 0.001) and 9% (aOR = 0.91, 95%CI 0.85-0.97, p = 0.004), respectively. Patients living in Son La (a mountainous province) were 1.72 times (95%CI 1.09-2.71) more likely to be non-adherent as compared to those in other areas (p = 0.020). As per univariate analyses, other associated factors could be age, education level, family monthly income, occupation, and opioid relapse (p < 0.001).

CONCLUSIONS

A high non-adherence rate was found among Vietnamese methadone maintenance patients. Interventions involving social support, occupation, income, and education are needed to improve their treatment adherence.

Predictors of concurrent heroin use among patients on opioid maintenance treatment in France: a multilevel study over 11 years

BACKGROUND

Consistent reports from health professionals suggest that heroin is commonly used by patients undergoing opioid maintenance treatment (OMT) in France, potentially jeopardizing their recovery process. However, there has been no formal epidemiological assessment on the matter.

METHODS

We use a yearly updated compendium retrieving information on patients admitted in treatment centres in France between 2010 and 2020. Given the hierarchical nature of the data collection, we conduct 2-level modified Poisson regressions to estimate the risks of past month heroin use among patients on OMT.

RESULTS

Despite an overall decreasing trend over time, heroin use among patients on OMT is indeed common, with half of patients declaring concurrent use. Our study unveils differentiated risks of heroin use vary according to the type of OMT, with patients on methadone more likely to use heroin compared to those on buprenorphine. The use of multilevel-related measures also uncovers high heterogeneity among patients' profiles, reflecting different stages in the treatment process, as well as differentiated practices across treatment centres.

CONCLUSION

Opioid maintenance treatment is associated with heroin use, in particular when methadone is involved. The heterogeneity among patients on OMT should be given particular attention, as it underscores the need for tailored interventions.