Association between Medical Compliance and Other Factors and the Retention Time of Methadone Maintenance Treatment among Intravenous Drug Abusers in Taiwan

• Main Authors: Min-Ju Wu, 吳旻儒
• Other Authors: Chen-Chang Yang
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/u8u994

碩士 === 國立陽明大學 === 公共衛生研究所 === 97 === Objectives：Drug abuse is an important issue in Taiwan. According to the data of the National Police Agency, it is estimated that there are 80 to 120 thousands drug abusers in Taiwan, with half of them ever injected heroin. Heroin can easily result in tolerance; which is very difficult to be detoxified. Heroin can also increase the risk of blood-borne infections, drug overdose, and violence or suicide related deaths through intravenous injection or multiple drug use. It has been reported that MMT （Methadone Maintenance Treatment, MMT） was inversely associated with opioid use, risk behaviors of HIV infection, and drug related-crimes. To reduce the risk of HIV and other blood-borne infections, MMT was introduced to Taiwan in late 2005 under the “Harm Reduction Project.” Very limited studies however have evaluated the efficacy of MMT, especially the relation between medical compliance and retention time at MMT clinics. Methods：A retrospective cohort study was conducted at a MMT clinic in Taipei city from April through July 2009 to understand the relation between patients’ medical compliance, demographic characteristics, illicit drug use, and MMT clinic retention time as well as liver injury. We further evaluated the characteristics of those non-respondents. Results：The retention rate after 360 days of MMT was 41%. Among those abusers who received treatment for more than 90 days, adherence to methadone therapy and positive morphine screen during MMT were positively associated with the retention time. In contrast, abusers being employed, with prior experience of MMT, more frequent drug screening during MMT, and history of amphetamine or Ecstasy abuse were inversely related to the retention time. Furthermore, patients who did not complete 90 days of MMT had poorer performance in attending the MMT clinic. The prevalence of HIV, HCV, and HBV was 12%, 87%, and 19%, respectively; none of the patients had sero-conversion. Syphilis sero-conversion is positively associated with distribution of HIV position. The prevalence of liver injury (defined by ALT> 80 U/L) was 14.5% in this study. Liver injury was related to illicit drug use during MMT and was associated with the risk of dropout by 360 days of MMT. Liver injury thus might be deemed as an index of regular attendance of MMT for at least 3 months. Conclusions: This study found that MMT retention rate was associated with medical compliance and other factors. Furthermore, many heroin abusers were noted to have liver injury and blood-borne infections, the presence of which was related to the abuse of specific illicit drugs. The study findings should be helpful to future improvements in increasing the retention rate of MMT and decreasing the health hazards of heroin abuse.