Methadone treatment - effectiveness and concerns

(Baonghean) - The drug addiction treatment program using Methadone has been implemented in our province since September 2012. After nearly 3 years, the program has brought many positive effects such as: helping addicts gradually give up drugs, improving the quality of life, reducing the risk of crime, contributing to ensuring social order and security, while limiting the risk of HIV infection and blood-borne diseases (hepatitis B, hepatitis C, etc.). However, there are still issues that need to be discussed surrounding Methadone treatment.

Expanding treatment facilities

The first Methadone treatment facility in our province is at the HIV/AIDS Prevention Center in Vinh City. Up to now, the whole province has had 4 more facilities established and put into operation in the districts: Que Phong, Quy Chau, Tuong Duong, and Labor Education Center No. 1. As of June 30, 2015, 936 patients were treated, reaching 27.53% of the target assigned by the Government.

Patients take Methadone at the Provincial HIVAIDS Prevention Center.

Over time, Methadone treatment has shown to be quite effective. Many patients who persevere, comply with treatment well, and take Methadone have gradually recovered their health, stabilized their psychology, and are able to work and work normally, escaping their dependence on drugs. In particular, the Methadone program has reduced the economic burden on addicts' families, limited the increase in drug-related crimes, drug trafficking and use, and contributed to stabilizing social order and security.

A typical example is the case of Mr. D in Hamlet 13, Dien An Commune, Dien Chau District. After more than 2 years of Methadone treatment (since June 2013), Mr. D. has had a more comfortable, happy, and healthier life. "Before, every time I had an attack, without drugs, I was always tired, struggling, and uncomfortable. Meanwhile, taking Methadone once a day, I no longer feel the craving for drugs, and I can eat and sleep" - Mr. D. shared. Many relatives, friends, and neighbors around him were also very happy because after a period of Methadone treatment, D. changed his temperament, lived a peaceful, frugal life, focused on making a living, and did not spend money on drugs like when he was addicted.

According to doctors, using Methadone orally, not by injection, reduces the rate of HIV infection due to injection. This treatment method also brings economic benefits because the cost is very cheap, taking it once a day. Meanwhile, if using drugs, users have to spend a lot of money, sometimes millions of dong because they have to use it many times a day. Methadone treatment not only benefits addicts, but also reduces the burden on families and society, limits HIV/AIDS infection and illegal acts related to drugs. According to the plan, from now until the end of 2015, more treatment facilities will be deployed in Thanh Chuong, Dien Chau districts, Thai Hoa town, Quy Hop, Ky Son, Con Cuong and Do Luong.

Dr. Nguyen Van Dinh, Director of the HIV/AIDS Prevention Center, said: "The program's advantage in recent years is that it has received the attention and strong direction of the province and related sectors. In Decision No. 3401 dated July 22, 2014 on approving the plan to adjust the implementation of the program for treatment of opioid addiction with Methadone in Nghe An in the period of 2014 - 2020, the Provincial People's Committee has increased the investment in the program in terms of funding, accordingly, if in 2014 the budget from the local budget for the program was 1 billion 530 million VND, in 2015 this figure was 5 billion 641 million VND. In addition, at the recent meeting of the Provincial People's Council, the Project on ensuring finance for the operation of Methadone treatment facilities was also approved. In addition, to prepare for projects from the Central Government to reduce the number of drugs, the Department of Health also submitted to the Provincial People's Committee for approval of the plan. Implement a model of socialized Methadone treatment, according to which instead of being supported 100% of treatment costs as at present, patients will contribute a part of 7,000 - 10,000 VND per dose.

In addition to expanding treatment facilities, aiming for efficiency and maintaining the number of patients, the health sector also directed treatment facilities to prepare for administrative procedures to receive patients according to Circular 12/2015/TT-BYT dated May 28, 2015 of the Ministry of Health detailing the implementation of a number of articles of Decree 96/2016/ND-CP regulating the treatment of opioid addiction with replacement drugs, effective from August 1, ensuring the right subjects, meeting treatment standards, and reducing waiting time for registrants. Previously, to be admitted to a Methadone treatment facility, patients had to apply and have confirmation from local authorities (ward, commune, town). This regulation has given rise to a problem in reality, as some local authorities, due to their lack of awareness of Methadone treatment, consider addicts as criminals, making it difficult for them to come and ask for confirmation. However, according to Circular 12, in the near future, those who register for treatment only need to fill out an application form according to the prescribed form and the treatment facility will be responsible for selecting the subjects to participate in treatment. With this regulation, subjects registering for Methadone treatment will be processed quickly and neatly, and can start treatment in just about a week.

Concerns

As of June 2015, Nghe An province had 7,293 drug addicts with controlled records. As one of the provinces with the largest number of drug addicts in the country, drug addiction treatment (both compulsory and voluntary) at drug addiction treatment centers in the province is facing many difficulties.

In the first 6 months of 2015 alone, these centers only managed and organized drug rehabilitation for 1,069 students; created conditions to help reintegrate into the community for 287 students and are currently managing 782 students. Thus, the number of 933 people receiving Methadone treatment accounts for a very small percentage compared to the number of drug addicts in society.

In addition, the rate of methadone treatment dropout in the province is still quite high. By the end of June 2015, out of 933 patients receiving methadone treatment, only 690 patients continued to maintain treatment, accounting for about 74%. More than 240 patients no longer receive treatment due to the following reasons: death or other illnesses that prevented them from receiving treatment, leaving the locality to work far away, being arrested and sent to prison, voluntarily requesting to stop treatment, and especially abandoning treatment for unknown reasons. According to Dr. Nguyen Van Dinh, although there are no official classification figures, it is estimated that there are more than 100 patients who voluntarily requested to stop or abandon treatment.

One of the reasons for this situation is that our province has a large area, with complex terrain in many places, but there are only 5 Methadone treatment facilities (including 2 facilities in Vinh City), making it difficult for many patients to travel for treatment. On the other hand, many patients still have wrong perceptions and lack determination in treatment. However, according to Dr. Nguyen Xuan Hong, Deputy Director of the Department of Health, there are still some problems that need to be improved in treatment facilities, such as inadequate counseling for patients; treating doctors and counselors are not closely connected; the reasons for each patient's abandonment of treatment have not been clearly investigated and analyzed; the search for those who abandon treatment to encourage them to return to treatment has not been actively carried out... The Methadone treatment program is also facing difficulties because some districts do not have synchronous coordination between the police, labor, war invalids and social affairs and health sectors in introducing and transferring patients.

In Decision No. 3401 on Approving the plan to adjust the implementation of the program of treatment of opioid addiction with Methadone in Nghe An in the period of 2014 - 2020, the goal set by 2020 is that over 40% of opioid addicts with control records in 100% of districts, towns and cities in our province will participate in the Methadone program. To achieve that goal, it requires the participation of Party committees, authorities, departments, branches and organizations in propaganda and mobilization so that drug addicts are aware of the effectiveness of drug addiction treatment with Methadone, thereby voluntarily participating and strictly complying with the treatment process.

During the treatment process, in addition to performing professional work, doctors need to create a close connection with patients through counseling conversations to provide timely support and encourage patients to maintain treatment. In counseling, doctors and counselors need to help patients and their families understand that Methadone treatment must be carried out long-term and almost for life, to avoid the situation where, after a period of treatment, they no longer crave heroin, some patients' families and they themselves think they have successfully quit, but stop treatment to save costs and travel time, not knowing that Methadone treatment must be carried out long-term and almost for life. Moreover, in the coming time, the authorities also need to study the combination of treatment programs with vocational training, loan support, and creating suitable, long-term jobs for patients, helping them stabilize their thinking and prevent drug addiction relapse. From there, the new Methadone treatment program can be more effective and sustainable.

Minh Quan