China ; Heroin Dependence ; rehabilitation ; Humans ; Methadone ; adverse effects ; therapeutic use ; Narcotics ; adverse effects ; therapeutic use

Buprenorphine ; therapeutic use ; Humans ; Methadone ; therapeutic use ; Naltrexone ; therapeutic use ; Narcotic Antagonists ; therapeutic use ; Narcotics ; therapeutic use ; Opioid-Related Disorders ; rehabilitation

Adult ; Heroin Dependence ; drug therapy ; prevention & control ; Humans ; Male ; Methadone ; therapeutic use ; Patient Compliance ; Treatment Outcome

Objective: To analyze the withdrawal in patients receiving methadone maintenance treatment (MMT) and its related influencing factors in Hubei province. Methods: The patients receiving MMT in clinics in Hubei province were selected from June 2006 to December 2021. The general demographic data, drug abuse history, and MMT information were collected. The survival data of patients with MMT were analyzed by the Kaplan-Meier method, and the Cox proportional hazards model was used for multivariate analysis. Results: A total of 26 716 patients receiving MMT were included in this study, and the gender ratio between men and women was 3.34∶1(20 557∶6 159). The duration of MMT was 0.01-15.72 years, and the median duration was 2.21 (95%CI: 2.16-2.26) years. At the end of the follow-up, the withdrawal proportion was 86.75% (23 175/26 716). MMT's 0-year, 2-year, 4-year, 9-year and 14-year cumulative probabilities appeared as 67.61%, 40.24%, 30.03%, 15.49% and 6.56%, respectively. Results from the Cox proportional hazards regression model showed that the factors of the withdrawal risk were higher in patients receiving MMT, including minority nationality (HR=1.66,95%CI:1.52-1.82), having jobs (HR=1.05, 95%CI:1.01-1.08), no history of compulsory isolation or detoxification (HR=1.04, 95%CI:1.01-1.09) and the enrollment in 2016-2021 (HR=1.46,95%CI:1.35-1.58). The factors of the withdrawal risk were lower in patients receiving MMT, including 60-year-olds or above (HR=0.56,95%CI:0.42-0.75), college degree or above education level (HR=0.83, 95%CI:0.75-0.91), outpatient services of other cities (HR=0.90, 95%CI:0.87-0.93), drug use for 20 years or more (HR=0.72, 95%CI:0.66-0.80), 90 mg or more per daily dosage (HR=0.73,95%CI:0.69-0.78) and the enrollment in 2011-2015 (HR=0.93,95%CI:0.89-0.97). Conclusions: The withdrawal proportions of patients receiving MMT were high in Hubei province. The withdrawal influencing factors were complex. The daily dose was an essential factor that can be intervened under the safe MMT condition, and a higher dose should be appropriately prescribed.
Male ; Humans ; Female ; Methadone/therapeutic use* ; Opiate Substitution Treatment ; Ambulatory Care ; Cities

Anxiety ; epidemiology ; China ; epidemiology ; Depression ; epidemiology ; Female ; Heroin Dependence ; drug therapy ; psychology ; Humans ; Male ; Methadone ; administration & dosage ; therapeutic use

OBJECTIVETo study the efficacy and safety of acupuncture therapy for the improvement of sleep quality of outpatients receiving methadone maintenance treatment (MMT).

METHODSUsing randomized double-blinded controlled design, seventy-five MMT outpatients with low sleep quality [score of Pittsburgh sleep quality index (PSQI) > or = 8], were randomly assigned to the acupuncture group (38 cases) and the sham-acupuncture group (37 cases). All patients maintained previous MMT. Acupuncture was applied to Baihui (GV20), Shenmen (bilateral, TF4), Shenting (GV24), Sanyinjiao (bilateral, SP6), and Sishencong (EX-HN1) in the acupuncture group. The same procedures were performed in the sham-acupuncture group, but not to the acupoints (5 mm lateral to the acupoints selected in the acupuncture group) with shallow needling technique. The treatment was performed 5 times each week for 8 successive weeks. The PSQI was assessed before treatment, at the end of the 2nd, 4th, 6th, and 8th week of the treatment. The detection ratio of low sleep quality and the incidence of adverse acupuncture reactions were compared between the two groups at the end of the 8th week.

RESULTSThe overall PSQI score was obviously higher in the acupuncture group than in the sham-acupuncture group with statistical difference (P < 0.01). The detection ratio of low sleep quality at the end of the 8th week was lower in the acupuncture group (60.53%, 23/38 cases) than in the sham-acupuncture group (83.78%, 31/37 cases) with statistical difference (P < 0.05). The rate of adverse acupuncture reaction was 5.26% (2/38 cases) in the acupuncture group and 2.70% (1/37 cases) in the sham-acupuncture group respectively, showing no statistical difference (P > 0.05).

CONCLUSIONAcupuncture therapy could effectively and safely improve the sleep quality of outpatients receiving MMT.

Acupuncture Therapy ; Adult ; Double-Blind Method ; Female ; Humans ; Male ; Methadone ; therapeutic use ; Outpatients ; Sleep ; Sleep Initiation and Maintenance Disorders ; therapy

OBJECTIVETo evaluate the reliability and validity of the Chinese version of addiction severity index (ASI)-5th version (ASI-C-5), in illegal drug users receiving methadone maintenance treatment (MMT) in China.

METHODSOne hundred and eighty-six heroin addicts (144 men and 42 women) receiving MMT at three clinics in Guizhou province, southwest China, were recruited. They were all interviewed with a questionnaire of ASI-C-5 and 35 were re-interviewed at an interval of seven days to assess its test-retest reliability.

RESULTSCronbach's alpha for internal consistency of CSs varied from 0.60 to 0.81 in all domains. Test-retest reliability of composite scores (CSs) of ASI-C-5 were satisfactory (r=0.38-0.97). Based on item analysis and expert's suggestions, five items were deleted and one item was modified in ASI-C-5. Criterion validity of ASI-C-5 was found acceptable, as compared to addicts' self-rating anxiety scale (SAS) and self-rating depression scale (SDS) (r=0.59 and 0.45) except for social support rating scale (SSRS).

CONCLUSIONSASI-C-5 can be used for heroin addicts receiving MMT with acceptable reliability and validity.

Adult ; China ; Female ; Heroin Dependence ; drug therapy ; physiopathology ; Humans ; Male ; Methadone ; therapeutic use ; Reproducibility of Results ; Severity of Illness Index ; Surveys and Questionnaires

Adult ; China ; Genes, Viral ; Genotype ; Hepacivirus ; genetics ; Hepatitis C ; virology ; Humans ; Methadone ; therapeutic use ; Middle Aged ; Opioid-Related Disorders ; virology

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 proportion of methadone maintenance treatment (MMT) clients continuing to use heroin and to explore its associated risk factors.

METHODSAll 1003 heroin addictive patients were recruited from eight MMT clinics in Guizhou province and followed up for 14 months. During the 14 months, each MMT client received random urine tests. MMT clinics, gender, marital status, employment, ethnicity, religion, previous drug using method, having a history being in detoxification program, age, methadone dosage, education level and length of drug use were treated as potential predicting variables into the GEE model.

RESULTSThe average age of the 1003 clients was (33.3 +/- 6.1) years old, the average length of drug use was (8.0 +/- 4.0) years, and the average daily methadone dosage was (38.0 +/- 16.6) mg. Among the 1003 clients, 26.0% were female drug users, 15.5% were divorced and 35.8% had a full time job. The rate of positive urine samples was approximately 30% for the first 10 months of follow-up, after which the positive rate decreased. The model found that different MMT clinics, the average daily methadone dosage (RR = 0.98, P = 0.003), treatment duration (RR = 0.95, P = 0.029) and years of education (RR = 0.94, P = 0.014) were associated with patients positive urine test.

CONCLUSIONContinued heroin use was common in MMT clinics in Guizhou province; increasing the dosage of methadone and the duration in the treatment program might decrease the continued use of heroin among clients in MMT clinics.

Adolescent ; Adult ; Ambulatory Care ; China ; epidemiology ; Female ; Heroin Dependence ; drug therapy ; epidemiology ; Humans ; Male ; Methadone ; therapeutic use ; Risk Factors ; Risk-Taking ; Young Adult