Methadone treatment dropout rates on the rise

(Baonghean) - Over time, the program of treatment of opioid substitution with Methadone (abbreviated as Methadone treatment) in Nghe An has produced many good results in reducing the number of drug addicts, reducing HIV infection, helping patients recover their health... However, recently, at many Methadone facilities, the number of patients dropping out of treatment has tended to increase.

No longer free

To help reduce and prevent drug abuse, in September 2012, Nghe An began operating drug rehabilitation facilities using Methadone. After 5 years, the province now has 12 Methadone treatment facilities and 16 satellite drug distribution points, with 1,200 patients undergoing treatment... The effectiveness of the program is evident as many patients have gradually stopped using drugs, recovered their health, found jobs and integrated into the community.

However, recently, at the facilities treating opioid addiction with Methadone in the highland districts such as Ky Son, Tuong Duong, Con Cuong... a "dangerous" situation has emerged - the number of patients dropping out of Methadone treatment has reached 50% - 75%. Among them, the highest rate of patients dropping out of treatment is in Tuong Duong district. According to management records, Tuong Duong has 786 addicts. At the end of 2014, the district opened a Methadone treatment facility, with 267 patients registered to participate. After more than a year, there were only 95 people left in treatment, meaning that up to 2/3 of the patients dropped out of treatment... The rate of dropping out of treatment in Ky Son district is also approximately 2/3, in Con Cuong district it is 1/2.

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

Mr. Pham Dinh H. in Nhung village, Tam Quang commune shared the reason for giving up treatment: “Two years ago, I received treatment for drug addiction at the Methadone facility at Tuong Duong District Medical Center, but due to the long distance, from my house to the center of Hoa Binh town is nearly 50km, going and returning takes almost a day, so I could not persevere, and did not have enough money for transportation. Only recently, Tam Quang Commune Medical Station (one of two satellite drug distribution facilities in the district) started Methadone treatment, so I came back.”

There are few treatment facilities, so patients who want to go for treatment are forced to travel very far (some patients have to travel nearly 100km). Lack of time, means of transportation, and accommodation costs are some of the main reasons why many people give up treatment. Another reason was given by Dr. Tran Van Cong - Deputy Director of Tuong Duong District Medical Center: "Because of livelihood, some patients work far away so they do not stick with treatment. There are also some who, after a period of treatment, feel no longer craving for drugs so they give up treatment and when their friends persuade them to do so, they become addicted again. A few others, due to illness or difficult family circumstances, give up on their own."

According to doctors at Methadone treatment facilities, another reason why patients stop treatment is because the Methadone treatment project's funding has run out. Addicts can no longer use it for free but will have to pay for treatment. The cost of Methadone treatment is 10,000 VND/person/day. This amount is not much for normal people, but for addicts in difficult areas, it is a challenge. Addicts themselves do not have money to buy regular medication, so they interrupt and then stop treatment altogether.

The solution is health insurance.

The fact that patients on Methadone treatment for many reasons abandon treatment and then relapse into addiction in some mountainous districts of Nghe An province has created a “vicious cycle”, leaving many consequences. To have money to buy drugs, addicts turn to crime, which can cause HIV/AIDS to spread and break out. This abandonment of treatment means that a lot of effort and money from the patients themselves, the support of the State, and the efforts of the entire political and social system become useless.

Checking the Meethadone treatment facility in Ky Son district. Photo: Thanh Hoa

Doctor Luyen Van Trinh - Deputy Director of the Provincial HIV/AIDS Prevention Center said: “The benefits for patients treated with Methadone are very clear. That is, it reduces the cost of buying and using illegal drugs; reduces and ends conflicts in the family; patients have positive changes both mentally and physically. In addition, patients have thought positively and found their own values, are responsible, know how to love, respect people, and cooperate with their families and treatment facilities.

At the beginning of the program, over 80% of patients receiving Methadone treatment had such positive changes." Doctor Luyen Van Trinh also commented that the current situation of patients abandoning Methadone treatment has a negative impact on drug addiction treatment. In the immediate future, to limit this situation, it is necessary to further strengthen communication work to each household so that people understand the benefits of treatment, strengthen close coordination with agencies and sectors to propagate and mobilize effective Methadone treatment, and soon expand satellite drug distribution facilities, especially in remote areas.

In the long term, the solution to the current treatment abandonment situation 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 evils. Recently, people with HIV/AIDS in our province have been supported to pay for health insurance as well as have had health insurance pay for ARV drugs. These two groups of patients are interrelated.

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

For the treatment of drug addicts, Methadone has been and is the most optimal therapy. Since 2011, the Ministry of Health has had a direction that when projects end in Vietnam, it will consider a support plan, bringing patients on Methadone treatment into the category of health insurance coverage like in developed countries. In 2013, Methadone was successfully produced domestically with a price about 30% lower than imported products (about 700,000 VND/liter)... However, up to now, this direction has not been transformed into specific steps.

Thanh Hoa - Thanh Son