Objective: To estimate the consumption level of four drugs in Beijing using wastewater-based epidemiology (WBE). Methods: The primary sludge from one large wastewater treatment plants (WWTPs) was collected in Beijing from July 2020 to February 2021. The concentrations of codeine, methadone, ketamine and morphine in the sludge were detected through solid-phase extraction-liquid chromatography-tandem mass spectrometry. The consumption, prevalence and number of users of four drugs were estimated by using the WBE approach. Results: Among 416 sludge samples, codeine had the highest detection rate (82.93%, n=345) with a concentration [M (Q₁, Q₃)] of 0.40 (0.22-0.8) ng·g^-1, and morphine had the lowest detection rate (28.37%,n=118) with a concentration [M (Q₁, Q₃)] of 0.13 (0.09, 0.17) ng·g^-1. There was no significant difference in the consumption of the four drugs on working days and weekends (all P values>0.05). Drug consumption was significantly higher in winter than that in summer and autumn (all P values <0.05). The consumption [M (Q₁, Q₃)] of codeine, methadone, ketamine and morphine in winter was 24.9 (15.58, 38.6), 9.39 (4.57, 26.72), 9.84 (5.18, 19.45) and 5.67 (3.57, 13.77) μg·inhabitant^-1·day^-1, respectively. For these drugs, there was an upward trend in the average drug consumption during summer, autumn and winter (the Z values of the trend test were 3.23, 3.16, 2.19, and 3.32, respectively and all P values<0.05). The prevalence [M (Q₁, Q₃)] of codeine, methadone, ketamine and morphine were 0.0056% (0.003 4%, 0.009 2%), 0.0148% (0.009 6%, 0.026 7%),0.0333% (0.0210%, 0.0710%) and 0.0072% (0.003 8%, 0.011 7%), respectively. The estimated number of drug users [M (Q₁, Q₃)] was 918 (549, 1 511), 2 429 (1 578, 4 383), 5 451 (3 444, 11 642) and 1 173 (626, 1 925),respectively. Conclusion: Codeine, methadone, ketamine and morphine have been detected in the sludge of WWTPs in Beijing, and the consumption level of these drugs varies in different seasons.
Humans ; Beijing ; Wastewater-Based Epidemiological Monitoring ; Sewage/analysis* ; Wastewater ; Ketamine/analysis* ; Codeine/analysis* ; Methadone/analysis* ; Water Pollutants, Chemical/analysis*

OBJECTIVETo explore factors associated with retention in a community-based methadone maintenance treatment (MMT) among heroin addicts in Xichang of Sichuan province.

METHODSAll 206 heroin addicts were first admitted to MMT community-based program between March to September 2004. Baseline data of patients characteristics, social function, drug using behaviors, sexual behaviors, dose of methadone and retention were collected.

RESULTSUp to Oct, 2005, all 206 patients contributed 8.98 +/- 5.74 person-months of following-up. The retention rates were 58.7% after 6 months and 34.6% after 12 months respectively. Cox proportional hazard regression model indicated that the employed (HR, 0.60; 95% CI, 0.39 - 0.92), helping family to do housework in past 30 days more than once a day (HR, 0.59; 95% CI, 0.42 - 0.82) and previous self-detoxification > or = 3 times (HR, 0.65; 95% CI, 0.47 - 0.91) were independently associated with retention.

CONCLUSIONWe should give individual counseling to help heroin addicts increasing compliance.

Adult ; Cohort Studies ; Community Health Services ; methods ; Female ; Heroin Dependence ; epidemiology ; rehabilitation ; Humans ; Male ; Methadone ; therapeutic use ; Middle Aged ; Prospective Studies ; Regression Analysis ; Treatment Outcome

OBJECTIVETo explore the routes and factors associated with HIV new infection of heroin addicts who had been attending the methadone maintenance treatment (MMT) program.

METHODSA 1 : 1 nested case-control study was implemented with the cases (new HIV infections) and controls (HIV negative) selected from the treatment cohort of China MMT clients. Questionnaire was developed to collect information on demographic characters, behaviours on drug use, sexual behaviour, daily dosage of methadone intake, adherence to MMT, and psychological problems. Univariate analysis and multivariate condition logistic regression were used to identify factors associated with HIV infection.

RESULTS108 (54 paired) clients on MMT were recruited, with 76 males and 32 females. Among them, 95 were Han Chinese and 13 were minorities, with average time of drug use as 12.1 ± 5.0 years. Among 54 new HIV infections, 33 were infected through sharing needles, 12 were through sexual contact and 9 unidentified. Results from multivariate condition logistic regression indicated that having longer duration of heroin use before on MMT (More than 10 years vs. less than 10 years,OR = 20.9, 95% CI:1.62-269.34, P = 0.02), shared needles in the last 6 months (OR = 276.7, 95%CI:5.65-> 999.99, P < 0.01) were risk factors while better adherence (More than 0.5 vs. less than 0.5,OR = 0.07, 95%CI:0.42-0.87, P = 0.04) and living with families (OR = 0.002, 95% CI:0.001-0.94, P < 0.01) were protective factors.

CONCLUSIONSharing needles was the main route of HIV new infection among those clients that were on MMT. Factors as having received more support from both family and community, improvement of adherence to MMT, reducing the frequency of injection etc., could reduce the risk of HIV infection among those MMT clients.

Adult ; Case-Control Studies ; Female ; Follow-Up Studies ; HIV Infections ; epidemiology ; Heroin Dependence ; complications ; drug therapy ; Humans ; Male ; Matched-Pair Analysis ; Methadone ; therapeutic use ; Middle Aged

OBJECTIVETo discuss the cost, cost-effectiveness, and cost-utility of the extension methadone maintenance treatment (MMT) clinics and provide the evidences of the strategy of scaling up the extension MMT clinics.

METHODSA study was conducted in Dehong prefecture, Yunnan province, including Mang, Ruili city, Longchuan, Yingjiang, Lianghe county. 117 newly enrolling heroin addict patients in 17 extension MMT clinics were recruited as subjects from December 2010 to February 2011. An interview was conducted by the trained interviewers for the quality of life score of patients, and the cost of drug use was calculated. Table of outpatient costs of methadone maintenance treatment clinic of Dehong prefecture in Yunnan was used for collecting and calculating the fixed cost, operating cost of the clinics, and the unit cost and incremental cost of the patients from 2008 to 2010. Cost-effectiveness and cost-utility of the extension clinics were analyzed by using the Markov model.

RESULTSThe total spending of extension clinics for 2008, 2009, and 2010 on average was ¥57 294, ¥80 752 and ¥74 739 respectively, or about ¥4379 annually per patient. The cost of averting one HIV infection was ¥316 509; the cost of averting one acquired immune deficiency syndrome (AIDS) patients was ¥508 676; and the cost of averting one death was ¥152 330. The cost of obtaining one life year (LY) was ¥3696 and the cost of obtaining one quality adjusted life year (QALY) was ¥9014. Comparing with drug users, the incremental cost utility ratio (ICUR) of the patients of the extension MMT clinics were -7074 yuan/QALY and -7162 yuan/LY.

CONCLUSIONThe extension MMT clinic service is lower in cost, and better in cost-effectiveness and cost-utility.

Ambulatory Care Facilities ; economics ; China ; Cost-Benefit Analysis ; Health Expenditures ; Heroin Dependence ; therapy ; Humans ; Methadone ; economics ; therapeutic use ; Opiate Substitution Treatment ; economics

OBJECTIVETo investigate the quality of life of heroin dependent patients with methadone maintenance therapy and its influencing factors.

METHODSTotally 462 heroin dependent patients who were receiving methadone maintenance therapy in Mangshi, Ruili, Longchuan, Yingjiang, Lianghe of Dehong prefecture, Yunnan province were randomly selected using proportional stratified sampling and interviewed with the WHO Quality of Life-BREF (QOL-BREF) in order to understand their quality of life in the fields of physical, psychological, social relationships, and environmental function during 4 weeks ago before interviewing, and the influencing factors of the quality of life.

RESULTSAmong the 462 patients, 451 patients (97.6%) were male and 11 (2.4%) were female. Their average age was (37.80 ± 9.13) years old; 145 patients (31.39%) unmarried, 270 patients (58.44%) were married; 35.93% (166/462) of patients had primary school education, 37.23% (172/462) of patients had senior high school education. The patients had a score of 54.11 ± 6.74 for total quality of life and well being and a score of 14.31 ± 2.23, 13.28 ± 1.79, 13.90 ± 2.52, 12.63 ± 1.77 for physical, psychological, social relationships and environmental function, respectively. The quality of life for physical, psychological, social relationships and environmental function of the group of patients which ages between 30 to 40, unmarried, high middle school and above education, length of drug addiction more than 10 years before receiving treatment, treatment duration less than 6 months, incoming from temporary job were with lower score for total quality of life and well being. The quality of life for physical, psychological was lower for those aged between 16 and 30 when becoming first time drug user, which scores were 14.29 ± 2.25 and 13.22 ± 1.84, respectively. The quality of life for physical, psychological, social relationships of the group of patients which injecting drug only or injecting drug with other manners before receiving treatment were lower, which scores were 13.92 ± 2.25, 13.08 ± 1.67, 13.25 ± 2.60 for injecting drug only and 13.67 ± 2.52, 13.43 ± 1.71, 13.80 ± 2.56 for injecting drug with other manners.

CONCLUSIONAttending and keeping methadone maintenance therapy could improve the quality of life of heroin dependent patients. Age, marriage status, education, time of drug use, treatment duration may be the influential factors.

Acquired Immunodeficiency Syndrome ; complications ; psychology ; Adolescent ; Adult ; China ; Factor Analysis, Statistical ; Female ; Humans ; Male ; Methadone ; administration & dosage ; therapeutic use ; Middle Aged ; Opioid-Related Disorders ; complications ; drug therapy ; psychology ; Quality of Life ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo study the prevalence of hepatitis C virus (HCV) infection and characteristics on molecular biology related to HCV among patients who were enrolled in a Methadone maintenance clinic in Wuhan.

METHODSSerum samples from 332 injection drug users (IDUs) were obtained and anti-HCV IgG was detected by enzyme linked immunosorbrent assay(ELISA), together with 86 anti-HCV positive specimens genotyped. A reverse transcriptase-polymerase chain reaction (RT-nPCR) assay using conserved primers deduced from the core-envelopel (C-E1) region of the HCV genome was employed to amplify a 474 bp fragment. Phylogenetic analysis of the C-E1 sequences was conducted by direct sequencing of the RT-nPCR products and alignment with determined by nucleotide sequencing followed by composition of a phylogenetic tree.

RESULTSThere were 313 cases (94.3%) appeared positive anti-HCV IgG in the 332 patients from a Methadone maintenance clinic in Wuhan. It was demonstrated that there were four different subtypes of HCV in that clinic in Wuhan, including 6a--71 cases (82.5%), 3b--7 cases (8.2%), 1a--5 cases (5.8%) and 1b--3 cases (3.5%).

CONCLUSIONInfection of 6a genotype HCV was predominant in patients from the Methadone maintenance clinic in Wuhan, followed by HCV 3b, 1a and 1b.

Adult ; Antibodies, Viral ; analysis ; China ; Enzyme-Linked Immunosorbent Assay ; Female ; Genotype ; Hepacivirus ; classification ; genetics ; Humans ; Male ; Methadone ; therapeutic use ; Middle Aged ; Phylogeny ; Reverse Transcriptase Polymerase Chain Reaction ; Substance Abuse Treatment Centers ; Substance-Related Disorders ; drug therapy ; rehabilitation ; Young Adult