scholarly journals Aproximacions a la perspectiva de la persona en tractament de manteniment amb metadona: Reflexions a propòsit de 10 anys de recerca / Approaches to the perspective of the individual receiving methadone maintenance treatment: Reflections on 10 years of research

Author(s):  
Joan Trujols Albet ◽  
Joan Guàrdia-Olmos ◽  
Ioseba Iraugui ◽  
José Pérez de los Cobos

 Resum. Els tractaments de manteniment amb metadona (TMM) són un autèntic tractament psicofarmacològic de la dependència d’heroïna i, a la vegada, un element indispensable de les polítiques i les intervencions de reducció de danys. L’efectivitat dels TMM ha estat avaluada, gairebé de manera exclusiva, mitjançant la utilització d’indicadors anomenats durs. Intentant anar més enllà d’aquest enfocament tradicional, hem portat a terme, durant els darrers 10 anys, diversos estudis emprírics i assaigs teòrics que s’emmarquen dins d’un objectiu global de generar coneixement al voltant de  –i amb– la perspectiva de la persona en TMM. En aquest article, resumim de manera selectiva les troballes més rellevants d’aquesta línia de recerca per discutir després algunes de les seves principals implicacions. Finalment, abordem alguns dels reptes  –i suggerim alguns dels canvis necessaris– per a una avaluació dels TMM realment centrada en el pacient.Summary. Methadone maintenance treatment (MMT) is both a specific psychopharmacological treatment of heroin dependence and a core harm-reduction intervention. Over the last 10 years we have been working to break the mould of the traditional focus on the so-called hard indicators of MMT effectiveness, pursuing instead a line of research that makes room for the consideration of the perspectives of methadone-maintained patients, resulting in several empirical and theoretical papers. Firstly, this commentary briefly and selectively summarizes some key findings from five of these papers. It then discusses the main implications of these findings. Finally, it addresses some of the challenges involved in conducting a genuinely patient-centred evaluation of MMT, along with some of the changes that would be required to accomplish this.

2016 ◽  
Vol 11 (2) ◽  
pp. 18
Author(s):  
Dessy Aryanti ◽  
Bagoes Widjanarko ◽  
Kusyogo Cahyo

ABSTRACTAccording to the risk factors as a result of injecting drug use (IDU) were second highest, after the heterosexual and homo-bisexual. In IDUs face two risks for contracting HIV / AIDS, from the use of unsterilized needles and performed together or alternately with other IDUs and also through sexual intercourse, especially that done with more than one partner without using a condom. Methadone maintenance treatment program (PTRM) is included in the Harm Reduction program – This is a program of harm reduction drug use in preventing transmission of HIV / AIDS. This research is quantitative with correlational design, sampling using the technique across sectional the total population 50 person IDUs of injecting drug users in the city of Cirebon -use structured questionnaires technique. From the 50 IDUs who were respondents in this research note that 68% did not use PTRM services. It is because most IDUs still can not stop using injection drugs and have not been willing to switch to PTRM. Results of univariate analysis to determine the level of knowledge of IDUs about PTRM 88% have a good category, the attitude of the respondents 80% have category support PTRM, family attitudes 50% have category support PTRM, attitudes of peers 72% have a category does not support the utilizations PTRM, attitude of health workers 66% category does not support PTRM, and the availability of facilities and health facilities 52% support in PTRM services. For the bivariate analysis showed that the attitude of IDUs to program substitution therapy methadone-related measures the utilization of PTRM, whereas knowledge factors, family attitudes, attitudes of peers, attitude of health workers, and the availability of facilities. Then knowledge of IDUs about PTRM shows no relationship with the actions the utilization of PTRM , And based on multivariate analysis known that the action the utilization of PTRM is influenced by the family attitudes were supportive of the utilizations of Methadone maintenance treatment program (PTRM).Keywords: drug, injection, PTRM, HIV/AIDS


2021 ◽  
Vol 18 (1) ◽  
Author(s):  
David Frank ◽  
Pedro Mateu-Gelabert ◽  
David C. Perlman ◽  
Suzan M. Walters ◽  
Laura Curran ◽  
...  

Abstract Background Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing risk of overdose, arrest, and transmission of blood-borne viruses like HIV and HCV among people that use opioids. Yet, MMT’s use of restrictive take-home dose policies that force most patients to attend their clinic on a daily, or near-daily, basis may be unpopular with many patients and lead to low rates of treatment uptake and retention. In response, this article examines how clinics’ take-home dosing policies have affected patients’ experiences of treatment and lives in general. Methods This article is based on semi-structured, qualitative interviews with a variety of stakeholders in MMT. Interviews explored: reasons for engaging with, or not engaging with MMT; how MMT is conceptualized by patients and treatment providers (e.g., as harm reduction or route to abstinence and/or recovery); experiences with MMT; perception of barriers to MMT (e.g., organizational/regulatory, social) and how MMT might be improved to support peoples’ substance use treatment needs and goals. Results Nearly all of the patients with past or present MMT use were highly critical of the limited access to take-home doses and consequent need for daily or near daily clinic attendance. Participants described how the use of restrictive take-home dose policies negatively impacted their ability to meet day-to-day responsibilities and also cited the need for daily attendance as a reason for quitting or avoiding OAT. Responses also demonstrate how such policies contribute to an environment of cruelty and stigma within many clinics that exposes this already-stigmatized population to additional trauma. Conclusions Take-home dose policies in MMT are not working for a substantial number of patients and are reasonably seen by participants as degrading and dehumanizing. Revision of MMT regulations and policies regarding take home doses are essential to improve patient satisfaction and the quality and effectiveness of MMT as a key evidence-based treatment and harm reduction strategy.


2020 ◽  
Vol 11 ◽  
Author(s):  
Qijian Deng ◽  
Maorong Hu ◽  
Fang Yu ◽  
Qiaosheng Liu ◽  
Wei Hao ◽  
...  

Background: Even though methadone maintenance treatment (MMT) is effective and widely recommended, it is widely misunderstood and stigmatized. This study aimed to explore people's attitudes and beliefs toward MMT, and stigmatization of MMT patients in China.Methods: This randomized, vignette-based study enrolled 1,066 household respondents (552 males and 514 females, response rate is 88.83%, 86.00% in vignette 1 and 91.66% in vignette 2) from two communities in China. Respondents initially completed questionnaires on sociodemographic characteristics and their knowledge about methadone and MMT. They were then randomly assigned to vignette 1 (described a patient receiving MMT) or vignette 2 (described a patient receiving amlodipine treatment). The labeling, stereotyping, and social distance toward the individual described in the vignettes were evaluated.Results: In these two vignettes, respondents showed a significantly higher level of stigma and discrimination toward the patient receiving MMT than the patient receiving amlodipine treatment. Approximately 60% of respondents believed that methadone is a type of addictive drug and that participating in MMT is a way to get high. Over 60% of respondents labeled the heroin-dependent patient who is receiving MMT as an addict even though the patient has not used heroin for several years; about 80% of them believed that the patient has undesirable characteristics and expressed a strong desire for social distance.Conclusions: People's misunderstanding of MMT, and stigmatization of MMT patients were very common among populations in the communities in China. To maximize MMT patients benefiting from MMT programs, more efforts are needed to minimize the impact of MMT-related stigma.


2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Bao-Liang Zhong ◽  
Wu-Xiang Xie ◽  
Jun-Hong Zhu ◽  
Jin Lu ◽  
Hongxian Chen

Abstract To date, there have been very limited studies regarding the clinical epidemiology of attempted suicide in Chinese individuals with heroin-dependence. The objective of this study was to examine the prevalence and correlates of suicide attempt in Chinese individuals receiving methadone maintenance treatment for heroin dependence. Demographic, clinical, and psychosocial data of 603 methadone-maintained patients with heroin dependence were collected with a standardized self-administered questionnaire. The presence of suicide attempt and antisocial personality disorder was assessed by using a single question and the Mini-International Neuropsychiatric Interview 5.0. The one-month and lifetime prevalence rates of suicide attempt were 9.5% and 34.2%, respectively. In multivariable logistic regression, lifetime suicide attempt was significantly associated with female gender (OR = 2.81), being 20–39 years old (OR = 2.73), an education level of primary school or lower (OR = 2.07), poor economic status (OR = 3.06), injecting heroin before methadone maintenance treatment (OR = 2.92), depressive symptoms (OR = 3.46), anxiety symptoms (OR = 1.88), and antisocial personality disorder (OR = 2.85). Suicide attempt is very prevalent among Chinese individuals receiving methadone maintenance treatment for heroin dependence. Services for patients with heroin dependence in methadone maintenance treatment clinics in China should include psychosocial supports, periodic screening for suicide attempt and other suicidal behaviors and, when needed, psychiatric treatment and crisis intervention.


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