A Study of 6-Year Retention in Methadone Maintenance Treatment Among Opioid-Dependent Patients in Xi’an.

J Addict Med. 2013 Jul 26;
Wei X, Wang L, Wang X, Li J, Li H, Jia W

We analyzed a 6-year methadone maintenance treatment (MMT) retention rate in 8 MMT clinics in Xi’an and the factors that influenced the retention rate.We conducted a 6-year retrospective dynamic cohort study of 5849 eligible patients from 2006 to 2011. Participants were serially enrolled on the basis of opioid addiction, age, residence status, and civil capacity. Cumulative retention in treatment was calculated using survival analyses (life tables) on the basis of the number of days in MMT. We also used the Cox proportional hazard regression model to analyze the factors that may influence treatment retention.The MMT retention varied from a less than 1 month to a maximum of 71.2 months; the average dose was 48.76 ± 17.03 mg/d. The cumulative retention for 12, 24, 36, 48, 60, and 72 months after MMT initiation were 0.87, 0.76, 0.66, 0.57, 0.49, and 0.43, respectively. The MMT retention rate was significantly associated with factors that included the particular clinic for MMT, the year when the subject initiated MMT, average daily dose, hidden drug use, sex, age, length of drug abuse history, needle sharing, living arrangements, and employment status.The 6-year retention rates for MMT in the 8 clinics in Xi’an were higher than those reported in other studies of other clinics. High therapeutic doses (>60 mg/d) could reduce the risk of patients withdrawing from treatment. Retention rates were relatively high in cohorts who were elderly, living with family, employed, or drug users, especially those with a long history of drug abuse.
HubMed – Methadone

Associations Among Hypothalamus-Pituitary-Adrenal Axis Function, Novelty Seeking, and Retention in Methadone Maintenance Therapy for Heroin Dependency.

J Addict Med. 2013 Jul 26;
Lin SH, Chen WT, Chen KC, Lee SY, Lee IH, Chen PS, Yeh TL, Lu RB, Yang YK

The efficacy of methadone maintenance therapy for heroin dependence is compromised by the low retention rate. Hypothalamus-pituitary-adrenal (HPA) axis function, which is associated with stress response, and novelty seeking (NS), a personality trait associated with low dopaminergic activity, may play roles in retention.We conducted a prospective study in which HPA axis function and NS were assessed by the dexamethasone suppression test and the Tridimensional Personality Questionnaire at baseline, respectively. The retention rate was assessed at the half- and 1-year points of methadone maintenance therapy.A low suppression rate of dexamethasone suppression test (D%) was associated with a high level of NS. A low D% was associated with half-year dropout, whereas a high level of NS was associated with 1-year dropout. Survival analysis confirmed that D% and NS were significant time-dependent covariates for retention.The findings showed that HPA axis function and NA were associated with retention at different time points.
HubMed – Methadone

Time to first treatment interruption in the Chinese methadone maintenance treatment programme.

Drug Alcohol Depend. 2013 Jul 26;
Sullivan SG, Wu Z, Detels R,

Methadone maintenance treatment (MMT) in China was established in 2004. The purpose of the present study was to estimate client retention and identify client factors associated with longer times in treatment.Data were abstracted from the MMT Data System from April 2008 to March 2010. Clients were considered to have interrupted treatment when they missed 30+ days of treatment. The median time in treatment was estimated using Kaplan-Meier methods and factors associated with the duration of treatment were evaluated using accelerated failure time models.Among 107,740 clients enrolled in MMT between 2008 and 2010, the median time spent in MMT among clients was 155 days but the majority (69%) did not attend every day. Estimated probabilities for treatment interruption were 53% at 6 months, 66% at 12 months and 77% at 24 months. Longer time in treatment was associated with doses ?60mg (Time ratio (TR)=2.12, 95%CI=1.96-2.30) and having tested negative on their last urine opiate test (TR=2.15, 95%CI=2.03-2.27). The effect of continued drug use was significantly modified by attendance. Sensitivity analyses indicated a dose-response relationship.Irregular attendance suggests there are barriers to accessing services that need further attention. The Chinese MMT programme needs effective strategies to improve its treatment durations.
HubMed – Methadone

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