Treatment Readiness, Attitudes Toward, and Experiences with Methadone and Buprenorphine Maintenance Therapy Among People Who Inject Drugs in Malaysia

Abstract

Background Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. Methods In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experience with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Results All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores. Conclusion There are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment.

Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia

“…Indeed, even in Malaysia’s largest study of PWID (N=460), which used respondent-driven sampling, only 17 (3.7%) women were successfully recruited despite increased recruitment incentives (42, 65). While women and men were not compared in the present sample, this study provides important insight into women’s substance use and related patterns, which may contribute to improved HIV prevention and treatment strategies in the future.…”

“…Information sessions were held at each venue and flyers posted describing the study purpose, potential risks, and benefits to participation were used to assist recruitment efforts. Convenience sampling was chosen over more representative sampling methods like respondent-driven sampling (RDS) due to serious challenges by one of the co-authors with recruiting female PWID in Malaysia using this method, in which only 17 (3.7%) of 460 recruited PWID were women, despite increased incentives offered to recruit women (42). Interested individuals met with trained research assistants who assessed eligibility (> 18 years of age and had used any illicit substance within the past 12 months), obtained written informed consent, and described the anonymous nature of the study and that participation could be terminated at any time without consequence.…”

Readiness to change is a predictor of reduced substance use involvement: Findings from a randomized controlled trial of patients attending South African emergency departments

“…This finding was surprising as studies with treatment-seeking populations have consistently reported that higher scores on this scale predict greater improvement in substance use outcomes [22,45,46]. There are two possible explanations for this finding.…”

“…Mixed findings have been found for the association between socio-demographic factors (such as age, race and gender), and RTC substance use [29,37]. While mental health problems such as depression are strongly associated with substance use problems [41] and several studies have shown that depression is associated with greater RTC substance use [42][43][44], others have found no significant association [41,45,46]. While methodological differences in the choice of RTC measures and depression screeners may account for these equivocal findings, the relationship between depression and RTC substance use, particular in ED populations, requires further study.…”

HIV Prevalence Among People Who Inject Drugs in Greater Kuala Lumpur Recruited Using Respondent-Driven Sampling

“…On average, participants at all sites reported injecting more than three times per day, and the vast majority were daily injectors (Table I). More detailed data on drug use and drug treatment are reported elsewhere (35,36). …”