Trade-offs in Substitution Treatment: A Qualitative Study of an Opioid Substitution Therapy Clinic as an Enabling and a Risk-Environment

This article present results from a study of clients experiences of attending a substitution treatment clinic in Copenhagen, Denmark. The study is part of a research project about the everyday lives of marginalized drug users in Copenhagen, their risk environments and their access to formal and informal resources. Thirty-eight clients participated in structured interviews, covering topics concerning, drug use, income, housing, social relations, violence, use of health and social services. A risk environment/enabling environment framework was developed to analyze the data. The research shows that the methadone clinic give the clients access to different material, social and affective resources, but that access to resources often involve different trade-offs. Such trade-offs include accepting control or socializing with drug users to get access to substitution medicine. Some clients accept such trade-offs, others do not and choose find other ways to get resources, exposing themselves to potential harm. This means that the clinic can function as an enabling, constraining and a risky environment for different clients.

Treatment adherence and related factors among patients in the unique MMT private clinic in Vietnam in 2018

A cross-sectional study using the take-all sampling method was conducted among patients in the unique MMT private clinic in Vietnam in 2018. The study aimed to describe treatment adherence status and related factors of the patients. Data on socioeconomic characteristics, behaviours, treatment process, level of social/family support were collected and analyzed. The results showed that 88.2% of MMT patients completely adhere to the treatment program. Factors positively related to treatment adherence of MMT patients were living with spouse/partner (OR = 3.02 95% CI: 1.11 – 8.19), not using illicit drugs during MMT treatment (OR = 5.88; 95% CI: 1.77 – 19.56). The methadone clinic should pay attention to the factors positively related to treatment adherence in the counselling and support process for the patients.

Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India

Background Opioid substitution therapy (OST) with buprenorphine has been widely available in India since 2007, but the introduction of methadone occurred much later in 2012, and availability remains limited. Illicit injecting drug use is a long-standing public health problem in Manipur, a state in Northeast India characterised by major resource constraints and political unrest. We investigated retention and outcomes for clients attending a methadone-based OST program in Manipur with the aim of strengthening the evidence base for development of relevant policies and programs. Methods All clients enrolling in the methadone clinic over a 1 year period were invited to be part of a prospective cohort study, which followed up and surveyed both retained and defaulting clients for 12 months post-enrollment to assess retention as well as social, behavioural and mental health outcomes. Additionally, we conducted semi-structured qualitative interviews to supplement quantitative information and identify factors contributing to retention and drop-out. Results Of the 74 clients enrolled, 21 had dropped out and three had died (all defaulters) by 12 months post-enrollment, leaving 67.6% still in the program. Using an intention-to-treat analysis, meaningful and statistically significant gains were observed for all social, behavioural and mental health variables. Between baseline and 12 months there were reductions in needle sharing, drug use, property crime, anxiety, depression and suicidal thoughts; and improvements in physical health, mental health, quality of family relationships, employment and hopefulness. Factors contributing to retention and drop-out were identified, including the centrality of family, and general lack of awareness of and misunderstanding about methadone. Conclusion Even in parts of India where resources are constrained, methadone is an effective treatment for opioid dependence. Scaling up the availability of methadone elsewhere in Manipur and in other areas of India experiencing problematic opioid dependence is indicated.