Factors associated with methadone maintenance therapy discontinuation among people who inject drugs

Lo, An-Ya; Kerr, Thomas; Hayashi, Kanna; Milloy, M‐J; Nosova, Ekaterina; Liu, Yang; Fairbairn, Nadia

doi:10.1016/j.jsat.2018.08.009

Cited by 48 publications

(26 citation statements)

References 38 publications

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“…Structural factors, like geographical location, economic conditions, employment, legal status and housing, are more predictive of initiation and retention in opioid agonist therapy [24,25] than individual factors. Lowthreshold programmes facilitate higher retention as they are designed to reduce barriers to entry (including eligibility criteria), are patient-centred, and take a nonpunitive approach to drug use and support people in situations of structural precariousness [26][27][28].…”

Section: Factors Influencing Retention In Opioid Agonist Therapymentioning

confidence: 99%

High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion

2020

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Background: Moral conservatism within government and communities has resulted in a reluctance to support the provision of opioid agonist therapy for people with opioid use disorders in South Africa. In April 2017, South Africa's first low-threshold opioid agonist therapy demonstration project was launched in Durban. The project provided 54 low-income people with heroin use disorders methadone and voluntary access to psychosocial services for 18 months. At 12 months, retention was 74%, notably higher than the global average. In this paper, we aim to make sense of this outcome. Methods: Thirty semi-structured interviews, two focus groups, ten oral histories and ethnographic observations were done at various project time points. These activities explored participants' pathways into drug use and the project, their meaning attributed to methadone, the factors contributing to project success and changes they experienced. Recordings, transcripts, notes and feedback were reviewed and triangulated. Key factors contributing to retention were identified and analysed in light of the existing literature. Results: The philosophy and architecture of the project, and social cohesion were identified as the main factors contributing to retention. The use of a harm reduction approach enabled participants to set and be supported to achieve their treatment goals, and was shown to be important for the development of trusting therapeutic relationships. The employment of a restorative justice paradigm provided a sense of acceptance of humanity and flaws as well as an imperative to act responsibly towards others, fostering a culture of respect. Social cohesion was fostered through the facilitation of group sessions, a peace committee and group sport (soccer). In concert, these activities provided opportunities for participants to demonstrate care and interest in one another's life, leading to interdependence and care, contributing to them remaining in the project. Conclusions: We believe that the high retention was achieved through attraction. We argue that opioid agonist therapy programmes should take the principles of harm reduction and restorative justice into consideration when designing low-threshold opioid agonist therapy services. Additionally, ways to support cohesion amongst people receiving agonist therapy should be explored to support their effective scale-up, both in low-middle income countries and in high-income countries.

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Section: Factors Influencing Retention In Opioid Agonist Therapymentioning

confidence: 99%

High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion

2020

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“…Most of these features are common to low threshold programmes, which show higher levels of retention than higher threshold services [17][18][19]. One of the most consistent predictors of retention is methadone dose [53][54][55]. The globally recommended daily dose range for methadone is 60-120 mg [11].…”

Section: Retentionmentioning

confidence: 99%

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

Scheibe

Shelly

Gerardy³

et al. 2020

Addict Sci Clin Pract

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Background: Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. Methods:We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. Results:The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). Conclusions:Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.

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“…Governments commonly employ cash transfer benefits to reduce socio‐economic and health inequities [46,47], with important benefits for PWUD [5,6]. Previous literature based on administrative data paradoxically identifies payment‐coincident elevations in drug‐related morbidity, mortality and service utilization pointing to a so‐called ‘cheque effect’ linked to monthly synchronized income assistance disbursement [13,18,21,25].…”

Section: Discussionmentioning

confidence: 99%

“…Cash transfer benefits provide financial support and are considered a crucial way in which states mitigate extreme poverty [1,2], improving health and reducing mortality among recipients [3,4]. For people who use drugs (PWUD), income assistance is additionally associated with reduced recidivism [5] and substance use disorder (SUD) treatment retention [6]. Notably, increased spending commonly follows income payments [7], including income assistance, which in North America are predominantly distributed on a synchronized monthly basis [8,9].…”

Section: Introductionmentioning

confidence: 99%

Drug‐related harm coinciding with income assistance payments: results from a community‐based cohort of people who use drugs

et al. 2020

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Background and Aims Income assistance is critical to the health and wellbeing of socio‐economically marginalized people who use illicit drugs (PWUD). However, past literature paradoxically identifies unintended increases in drug‐related harm coinciding with synchronized payments that may magnify signals for drug use. The scope of such harm has not been fully characterized among non‐institutionalized populations. This study examined socio‐demographic, health and drug use‐related correlates of payment‐coincident drug‐related harm. Design This observational study uses data from prospective community‐based longitudinal cohorts of PWUD between December 2013 and May 2018. Setting Vancouver, British Columbia, Canada. Participants A total of 1604 PWUD receiving monthly income assistance. Our sample included 586 (36.5%) women, 861 (53.7%) non‐white participants and 685 (42.7%) people living with HIV. Measurements The primary outcome was a self‐reported composite measure of drug‐related harm in the past 6 months coinciding with income assistance, including higher‐frequency substance use, non‐fatal overdose and service barriers or interruptions. Subanalyses disaggregated this outcome. Findings Payment‐coincident drug‐related harm was reported among 77.7% of participants during the study period. In multivariable models, key correlates positively and significantly associated with payment‐coincident harm included: street‐based income generation [adjusted odds ratio (aOR) = 1.48, 95% confidence interval (CI) = 1.26–1.74, P < 0.001], sex work (aOR = 1.66, 95% CI = 1.35–2.04, P < 0.001), illegal income generation (aOR = 1.57, 95% CI = 1.35–1.83 P < 0.001), homelessness (aOR = 1.34, 95% CI = 1.13–1.58, P < 0.001), exposure to violence (aOR = 1.31, 95% CI = 1.03–1.66, P = 0.032), daily crack cocaine use (aOR = 1.99, 95% CI = 1.59–2.50, P < 0.001), heavy alcohol use (aOR = 1.64, 95% CI = 1.37–1.97, P < 0.001) and injection drug use (aOR = 2.55, 95% CI = 2.01–3.23, P < 0.001). In subanalyses, specific harms were more likely among individuals reporting social, structural and health vulnerabilities. Conclusions In Vancouver, Canada, people who use illicit drugs who receive income assistance report high prevalence of payment‐coincident drug‐related harm, particularly people experiencing socioeconomic and structural marginalization or engaging in high‐intensity drug use.

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Factors associated with methadone maintenance therapy discontinuation among people who inject drugs

Cited by 48 publications

References 38 publications

High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion

High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

Drug‐related harm coinciding with income assistance payments: results from a community‐based cohort of people who use drugs

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