Increased rate of Methadone treatment abandonment.

(Baonghean) - Over time, the Methadone-based opioid substitution treatment program (referred to as Methadone treatment) in Nghe An has yielded many positive results in reducing the number of drug addicts, decreasing HIV transmission, and helping patients recover their health... However, recently, at many Methadone facilities, the rate of patients abandoning treatment has been increasing.

No longer free

To contribute to minimizing and preventing drug abuse, in September 2012, Nghe An province began operating drug rehabilitation centers using Methadone. After 5 years, the province now has 12 Methadone treatment centers and 16 satellite drug dispensing points, with 1,200 patients currently undergoing treatment... The effectiveness of the program is evident as many patients have gradually overcome drug addiction, recovered their health, found employment, and reintegrated into the community.

However, recently, a "dangerous" situation has emerged at methadone-based opioid addiction treatment centers in mountainous districts such as Ky Son, Tuong Duong, and Con Cuong... - the number of patients abandoning methadone treatment has reached 50% - 75%. The highest abandonment rate is in Tuong Duong district. According to records, Tuong Duong has 786 addicts. At the end of 2014, the district opened a methadone treatment center, with 267 patients registering. More than a year later, only 95 patients remained, meaning that two-thirds of the patients had abandoned treatment... The abandonment rate in Ky Son district is also approximately two-thirds, and in Con Cuong district it is one-half.

Dispensing Methadone to patients at Con Cuong District Health Center. Photo: Thanh Son

Mr. Pham Dinh H. from Nhung village, Tam Quang commune, shared his reason for abandoning treatment: “Two years ago, I was undergoing addiction treatment at the Methadone facility at the Tuong Duong District Health Center, but because of the long distance, nearly 50km from my home to Hoa Binh town center, taking almost half a day for the round trip, I couldn't persevere, and I also didn't have enough money for transportation. Only recently, the Tam Quang Commune Health Station (one of the two satellite drug dispensing facilities in the district) started offering Methadone treatment, so I returned.”

There are few treatment facilities, and patients who want treatment are forced to travel very far (some patients have to travel nearly 100km). Lack of time, transportation, and living expenses are among the main reasons why many people abandon treatment. Another reason, according to Dr. Tran Van Cong - Deputy Director of the Tuong Duong District Health Center: "Due to livelihood needs, some patients go to work far away and do not continue treatment. Some people, after a while, no longer feel the craving for drugs and quit treatment, only to relapse when tempted by friends. A few others quit on their own due to illness or difficult family circumstances."

According to doctors at Methadone treatment centers, another reason patients abandon treatment is that the Methadone treatment project's funding has run out. Addicts no longer receive free treatment and must pay for it themselves. The cost of Methadone treatment is 10,000 VND per person per day. This amount may not be large for an average person, but it is a significant challenge for addicts in disadvantaged areas. Addicts themselves lack the money to buy the medication regularly, leading to interruptions and eventually abandonment of treatment altogether.

The solution is health insurance.

In some mountainous districts of Nghe An province, patients abandoning Methadone treatment for various reasons and relapsing into drug use have created a vicious cycle, leading to many negative consequences. To obtain money for drugs, addicts turn to crime, potentially causing the spread and outbreak of HIV/AIDS. This abandonment of treatment means that much of the patients' own effort and money, the government's support, and the efforts of the entire political and social system become wasted.

Inspecting a Meethadone treatment facility in Ky Son district. Photo: Thanh Hoa

Dr. Luyen Van Trinh, Deputy Director of the Provincial HIV/AIDS Prevention and Control Center, stated: “The benefits for patients treated with Methadone are very clear. These include a significant reduction in the cost of purchasing and using illegal drugs; a reduction and elimination of conflicts within the family; and positive changes in both the mental and physical health of the patients. Furthermore, patients have developed a more positive outlook, rediscovered their self-worth, become more responsible, learned to love and respect others, and cooperated with their families and treatment facilities.”

"At the beginning of the program, over 80% of patients receiving Methadone treatment showed such positive changes." Dr. Luyen Van Trinh also noted that the current situation of patients abandoning Methadone treatment negatively impacts drug addiction treatment. To mitigate this situation, it is necessary to further strengthen communication efforts reaching every household so that people understand the benefits of treatment, enhance close coordination with relevant agencies and departments to effectively promote and encourage Methadone treatment, and expand the number of satellite dispensing facilities, especially in remote areas.

In the long term, the solution to the current problem of treatment abandonment is that Methadone needs to be available in every locality where patients live. In Vietnam today, people with HIV/AIDS and drug addicts are considered patients, no longer social problems. Recently, people with HIV/AIDS in our province have received support for health insurance coverage and have had their ARV medication covered by health insurance. These two groups of patients are interconnected.

Mr. La Van S - a patient undergoing Methadone treatment - expressed his wish: "I hope that Methadone will be covered by health insurance and that it will be available at all health centers. If that were the case, surely no one would abandon treatment."

Methadone has been and continues to be the most optimal treatment for drug addicts. Since 2011, the Ministry of Health has had a plan to consider supporting and including Methadone-treated patients in the health insurance coverage scheme, similar to developed countries, upon completion of projects in Vietnam. In 2013, domestically produced Methadone was successfully manufactured at a cost approximately 30% lower than imported versions (around 700,000 VND/liter)... However, to date, this plan has not translated into concrete steps.

Thanh Hoa - Thanh Son