Lifetime multiple substance use pattern among heroin users before entering methadone maintenance treatment clinic in Yunnan,China

Introduction and Aims. Multiple substance use leads to greater levels of psycho‐behavioural problems, unsafe sex, and therefore a high risk of contracting sexually transmitted diseases, and is also more difficult to treat. This study aims to determine pattern of lifetime multiple substance use among Chinese heroin users before entering methadone maintenance treatment clinic. Design and Methods. A survey to obtain retrospective longitudinal data on lifetime multiple substance use was conducted among 203 heroin users in two of the biggest methadone maintenance clinics in Kunming City, Yunnan province. Results. All participants used more than one substance in their lifetime. Most of them used four or more substance groups (range two to seven groups). The most common substance patterns in lifetime use were alcohol, tobacco, opiates and depressants. Approximately 80% of them had a history of simultaneous substance use (co‐use). The most common combination of co‐use pattern was heroin with depressant. Common reasons for co‐use were to get high, to experiment, to sleep and to increase the potency of other drugs. Determinants of co‐use were education, marital status and family relationship. Discussion and Conclusions. Multiple substance use is highly prevalent among Chinese heroin users. Depressants are the most common substances used in combination with heroin.[Li L, Sangthong R, Chongsuvivatwong V, McNeil E, Li J. Lifetime multiple substance use pattern among heroin users before entering methadone maintenance treatment clinic in Yunnan, China. Drug Alcohol Rev 2010]     

Predictors of early dropout in methadone maintenance treatment program in Yunnan province,China

Introduction and Aim. The aim of this study is to identify the predictors of early dropout of patients in methadone maintenance treatment (MMT) clinics in Yunnan province, China. Methods. A cohort study was conducted on 218 patients starting treatment in five MMT clinics between 1 March 2008 and 31 August, with follow up to 28 February 2009. Patients were interviewed using a semistructured questionnaire covering socio‐demographic characteristics and drug abuse history. Attendance at clinic and daily dose were abstracted from the clinic records. The mean average daily dose per patient in each period was compared across three periods, 0–1, >1–3 and >3–6 months, using analysis of variance and random‐intercept mixed linear regression modelling. Cox regression model with time‐varying average daily dose within each period was performed to identify factors predicting dropout in the MMT program. Results. Cumulative probability of retention at 1, 3 and 6 months was 94%, 75% and 57%, respectively. There was no relationship between dose and probability of dropout in periods 1 and 2. However, after 3 months higher average daily dose (>60 mg) was associated with lower probability of dropout. Dropout was more likely among the Han ethnic group [hazard ratio (HR) = 1.86, 95% confidence interval (CI): 1.65–3.26], in those who had to spend over 30 min to visit the clinic (HR = 1.63, 95% CI: 1.07–2.49) and in those living with other drug users (HR = 2.71, 95% CI: 1.55–4.74). Discussion and Conclusion. Patients' early dropout was related to ethnicity, clinic accessibility, living with drug users and methadone dose. A higher methadone dose as appropriate for maintenance treatment is recommended.[Che Y, Assanangkornchai S, Mcneil E, Chongsuvivatwong V, Li J, Geater A, You J. Predictors of early dropout in methadone maintenance treatment program in Yunnan province, China. Drug Alcohol Rev 2010]     

Case-control study on oesophageal cancer in southern Thailand

A case-control study was conducted in southern Thailand to test the hypothesis that alcohol consumption, smoking, rubber processing and nutritional deficiency were risk factors for oesophageal cancer. Cases (n = 40) were recruited from patients admitted to the University Hospital, where the first interview took place. Age- and sex-matched controls (n = 129) were selected from closest neighbours of the case. The case:control ratio varied from 1:1 to 1:6, depending on the availability of controls. Logistic regression analysis gave a relative risk for drinking and smoking of 5.7 (95% confidence interval (CI) = 2.1-15.1), whereas the relative risk for alcohol drinking only was 4.7 (95% CI = 0.5-42) and for smoking only was 1.6 (95% CI = 0.7-4). Data on dietary habits were not analysed because of great variation. Rubber processing was not a significant risk factor. It was concluded that combined alcohol and cigarette consumption are important risk factors for oesophageal cancer in southern Thailand.