Changing attitudes and beliefs of staff working in methadone maintenance programs

Starting in 1989, an attempt was made to change the aim of methadone treatment in NSW from abstinence to harm-minimisation. A study was undertaken to measure change in attitudes among staff working in public methadone programs in Sydney. Using scales developed in a 1989 survey, we found a statistically significant and meaningful reduction in support for abstinence-oriented policies had occurred by 1992. There was no change in staff?s support for the punishment of illicit drug use or their knowledge of the risks and benefits of methadone maintenance. This suggests problems with staff attitudes and, indirectly, the effectiveness of public health interventions, can be addressed using educational campaigns.     

Methodology for the Randomised Injecting Opioid Treatment Trial (RIOTT): evaluating injectable methadone and injectable heroin treatment versus optimised oral methadone treatment in the UK

Whilst unsupervised injectable methadone and diamorphine treatment has been part of the British treatment system for decades, the numbers receiving injectable opioid treatment (IOT) has been steadily diminishing in recent years. In contrast, there has been a recent expansion of supervised injectable diamorphine programs under trial conditions in a number of European and North American cities, although the evidence regarding the safety, efficacy and cost effectiveness of this treatment approach remains equivocal. Recent British clinical guidance indicates that IOT should be a second-line treatment for those patients in high-quality oral methadone treatment who continue to regularly inject heroin, and that treatment be initiated in newly-developed supervised injecting clinics.     

Heroin-assisted treatment as a response to the public health problem of opiate dependence

Injection drug use (involving the injection of illicit opiates) poses serious public health problems in many countries. Research has indicated that injection drug users are at higher risk for morbidity in the form of HIV/AIDS and Hepatitis B and C, and drug-related mortality, as well as increased criminal activity. Methadone maintenance treatment is the most prominent form of pharmacotherapy treatment for illicit opiate dependence in several countries, and its application varies internationally with respect to treatment regulations and delivery modes. In order to effectively treat those patients who have previously been resistant to methadone maintenance treatment, several countries have been studying and/or considering heroin-assisted treatment as a complementary form of opiate pharmacotherapy treatment. This paper provides an overview of the prevalence of injection drug use and the opiate dependence problem internationally, the current opiate dependence treatment landscape in several countries, and the status of ongoing or planned heroin-assisted treatment trials in Australia, Canada and certain European countries.     

HIV transmission and the cost-effectiveness of methadone maintenance

OBJECTIVES: This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic. METHODS: We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%. RESULTS: Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10,900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14,100 and $15,200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots. CONCLUSIONS: Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population.     

Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs.

One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs.     

Controlling illegal stimulants: a regulated market model

Prohibition of illegal drugs is a failed social policy and new models of regulation of these substances are needed. This paper explores a proposal for a post-prohibition, public health based model for the regulation of the most problematic drugs, the smokable and injectable stimulants. The literature on stimulant maintenance is explored. Seven foundational principles are suggested that could support this regulatory model of drug control that would reduce both health and social problems related to illegal stimulants. Some details of this model are examined and the paper concludes that drug policies need to be subject to research and based on evidence.     

Approaches to methadone treatment: harm reduction in theory and practice

The paper analyses methadone treatment in Copenhagen -- as it is described by methadone users and staff at different outpatient centres. The starting point is a theoretical model distinguishing between two different approaches to methadone treatment: 'palliative' and 'curative'. Included in the model are three dimensions (1) treatment goals at the methadone centres (abstinence vs. stabilisation) (2) treatment focus (focus on addiction vs. focus on the consequences of addiction) and (3) conceptualisation of methadone (methadone as similar to or different from heroin). The paper shows that there is a discrepancy between the attitudes of the staff and those of the users. While the staff favour an almost clear-cut palliative approach to methadone treatment, defining curative goals as both unrealistic and as belonging to the past, the users prefer an approach that does not exclude the goal of abstinence and does not focus on the consequences of drug use alone but also on their problematic relationship to drugs (legal as well as illegal). Furthermore, the users' attitudes towards methadone are far more ambivalent than the staff's. For the users, methadone is not just medicine; it is also a dependence-producing and 'dangerous' drug.     

Attitudes and practices regarding the use of methadone in US State and federal prisons

In the United States, vigorous enforcement of drug laws and stricter sentencing guidelines over the past 20 years have contributed to an expanded incarcerted population with a high rate of drug use. One in five state prisoners reports a history of injection drug use, and many are opiate dependent. For over 35 years, methadone maintenance therapy has been an effective treatment for opiate dependence; however, its use among opiate-dependent inmates in the United States is limited. In June 2003, we conducted a survey of the medical directors of all 50 US states and the federal prison system to describe their attitudes and practices regarding methadone. Of the 40 respondents, having jurisdiction over 88% (n=1,266,759) of US prisoners, 48% use methadone, predominately for pregnant inmates or for short-term detoxification. Only 8% of respondents refer opiate-dependent inmates to methadone programs upon release. The results highlight the need to destigmatize the use of methadone in the incarcerated setting, expand access to methadone during incarceration, and to improve linkage to methadone treatment for opiate-dependent offenders who return to the community.     

Methadone maintenance—lessons from two systems in China

In Hong Kong, methadone maintenance treatment (MMT) was launched in the 1970s, almost 30 years before the counterpart programme’s inauguration in Mainland China. Both were established in response to perceived public crises—addiction-related crime and HIV outbreak, respectively—and both are now regular services under two systems in the same country. Effectiveness of MMT in achieving the stated goals was evident in each case and provides useful lessons on strategies for dealing with the varied concerns related to illicit drug use. Today, with changing patterns of drug addiction, increasing competition for resources, and changing attitudes towards addiction and its treatment, the two MMT systems are confronted with similar challenges to achieve sustainability.     

国家海洛因成瘾者社区药物维持治疗个旧试点效果分析

[目的]在禁毒和艾滋病防制工作中,探索新的行为干预模式。有效解决海洛因依赖者的生理依赖和因静脉注射吸毒引发的艾滋病传播及社会治安等问题。[方法]通过口服美沙酮药物,为海洛因药物依赖者提供合法、安全、有效的维持治疗方法。[结果]药物维持治疗效果明显,方法可靠,操作技术简便,具有良好的推广价值和市场潜力。[效果]美沙酮维持治疗在减少高危行为降低吸毒危害、减少违法犯罪、恢复家庭和社会功能方面取得了十分满意的效果。     

美沙酮门诊工作人员美沙酮-AIDS KAP调查分析

目的了解美沙酮门诊工作人员对美沙酮与AIDS的知识、态度以及相关行为特点,探讨现阶段门诊工作中存在的问题。方法在西藏自治区对3类美沙酮门诊医护人员进行相关知识的掌握和需求调查,通过问卷的方式获取研究对象资料,采用Excel软件进行数据录入,SPSS 16.0进行统计分析。结果本次研究共调查149人,其中132人(88.6%)知道感染AIDS病毒的人从外表不能看出来;135人(90.6%)知道美沙酮属于强效阿片受体激动剂,能控制阿片类的戒断症状;48人(32.2%)表示愿意与AIDS病人生活在同一社区;121人(81.2%)认为应该给坚持服药的病人奖励;127人(85.2%)会向朋友及亲属讲述美沙酮维持治疗相关知识。结论美沙酮门诊工作人员对AIDS及美沙酮知识有较高的认知水平,但仍有待提高;美沙酮门诊工作人员对待AIDS病人及吸毒者的态度较差;对相关工作人员的培训需有针对性,寻求新的突破口与思路。     

The content and comprehensiveness of hepatitis C education in methadone maintenance and drug-free treatment units

Although drug users are at elevated risk for hepatitis C virus (HCV) infection, many are uniformed or misinformed about the virus. Drug treatment programs are uniquely situated to provide comprehensive risk-modifying educational programs for decreasing HCV transmission, a strategy advocated in the most recent National Institutes of Health Consensus Development Conference Statement on the Management of Hepatitis C. Given the large proportion of patients that inject drugs in methadone maintenance treatment programs and the high prevalence of HCV among drug injectors, we compared a nationwide sample (N=246) of methadone maintenance treatment programs and drug-free programs regarding the content and comprehensiveness of HCV education. All of these programs provide HCV education to at least some of their patients. Results indicated that, compared to drug-free programs, methadone maintenance treatment programs cover a significantly greater number of HCV-related topics, and that a significantly greater proportion of the methadone programs cover specific topics (e.g., how to avoid transmitting HCV, the importance of testing for HCV, treatment options if HCV positive). Of special concern is that fewer than three quarters of the drug-free programs address what to do if co-infected with human immunodeficiency virus (HIV) and HCV and how to maintain health if HCV positive, and only about half of the drug-free and methadone maintenance treatment programs educate HCV-positive patients about the importance of obtaining vaccinations for hepatitis A and B. Drug treatment programs need to educate patients about the proactive steps these individuals can take to deal with HCV, provide critically needed HCV services, and encourage patients to make full use of these services.     

Beliefs about methadone in an inner-city methadone clinic

Despite being considered both the most effective treatment for beroin addiction and an essential tool in the prevention of buman immunodeficiency virus (HIV), methadone maintenance (MM) is often held in low esteem by beroin addicts—even those in MM treatment. This survey examined current beliefs and attitudes about MM of patients at an inner-city clinic, and the personal experience and attitudes of these patients with this treatment. Consenting patients in a methadone clinic serving a poor population with high rates of human immunodeficiency virus infection were queried about their attitudes toward and beliefs about methadone using a 16-item questionnaire. Over 2 days, 315 questionnaires were completed (acceptance rate 40%), totaling 32% of the 1000 clinic patients. Nearly 80% believed that methadone bad a positive effect on bis or ber life, but 80% were certain or unsure as to whether methadone is bad for one's bealth, and a similar percentage (80%) believed that discontinuing methadone was an important goal. Patients continue to have strongly negative attitudes toward and beliefs about methadone despite their acknowledgement that methadone has been very positive for them as individuals. As a result, many patients leave MM treatment prematurely, and there are usually unfilled slots in MM programs in New York City, even while continued need exists (e.g., less than 25% of the beroin addicts in the city are in treatment). The restrictive nature of many MM programs may account for these attitudes and beliefs. Weill Medical College of Cornell University; and Dr. Drucker is with Montefiore Medical Center/Albert Einstein College of Medicine.     

胶体金法与酶联免疫法检测丙型肝炎病毒抗体的比较

目的结合临床实践经验,开展胶体金法与酶联免疫法检测丙型肝炎病毒抗体的比较研究。方法选取本站美沙酮维持治疗中心接受药物治疗的吸毒患者611例为研究对象,采用试验研究方法,常规采集吸毒人员的静脉血,离心取血清备用。采用英科新创（厦门）科技有限公司生产的丙型肝炎病毒抗体诊断试剂盒（胶体金法）和北京万泰生物药业股份有限公司生产的丙型肝炎病毒抗体诊断试剂盒（酶联免疫法）,对上述研究对象进行检查,探讨两种方法的有效性。采用χ2检验,取P〈0.05为差别有统计学意义。结果本次研究结果显示,两种方法的检验阳性率差别无统计学意义（χ2=1.21,P〉0.05）。提示两种方法均可用于临床检验,其有效性值得肯定。结论胶体金法具有操作简便、时间短、观察直观、不需特殊设备、经济可靠等特点,且可单份测定,尤其在急诊及临床应用中具有较强的优势,已在生物医学领域,尤其是医学检验得到广泛应用,可作为筛查丙型肝炎病毒抗体的重要手段,对丙型肝炎的早期发现以及预防控制有重要参考价值和意义。     

美沙酮维持治疗影响因素

目的了解美沙酮维持治疗门诊（MMT）服药人员坚持治疗的影响因素。方法采用整群抽样的方法抽取成都市2家美沙酮门诊服药人员810人进行横断面问卷调查。结果调查得到806份有效问卷,38.7%的人承认曾经中断过美沙酮维持治疗,23.6%的人承认曾经偷吸过,68%的人承认曾经注射过毒品,其中14.4%的承认与他人共用过注射器具。结论 MMT门诊患者治疗中断的因素为服用药物的量,服用药物的量越高越不容易中断治疗;MMT门诊患者偷吸的主要因素为工作情况和是否共用针具,工作情况越不稳定越容易偷吸,共用过针具的人偷吸的概率是没有共用针具的人的2倍左右。     

Perpetration of intimate partner violence among men in methadone treatment programs in New York City

This study examined the prevalence of perpetration of intimate partner violence among 356 men recruited from methadone maintenance treatment programs. We used logistic regression with covariance adjustment to examine the associations between intimate partner violence and illicit drug use by the participants, their female partners, or both. We found a high prevalence of intimate partner violence among the men in our sample. Significant associations between intimate partner violence and illicit drug use varied by types of drugs and whether the female partner or both partners were using drugs.