Methadone Maintenance Treatment in Spain: The Success of a Harm Reduction Approach.
Methadone maintenance treatment in Spain: the success of a harm reduction approach.
Bull World Health Organ. 2013 Feb 1; 91(2): 136-41
Torrens M, Fonseca F, Castillo C, Domingo-Salvany A
During the 1980s, Spain had very strict laws limiting access to opioid agonist maintenance treatment (OAMT). Because of this, mortality among people who used illicit opioids and other illicit drugs was high. Spain was also the European country with the highest number of cases of acquired immunodeficiency syndrome transmitted through illicit drug injection.The rapid spread of human immunodeficiency virus (HIV) infection among people using heroin led to a shift from a drug-free approach to the treatment of opioid dependence to one focused on harm reduction. A substantial change in legislation made it possible to meet public health needs and offer OAMT as part of harm reduction programmes in the public health system, including prisons.Legislative changes were made throughout the country, although at a different pace in different regions.Legal changes facilitated the expansion of OAMT, which has achieved a coverage of 60%. A parallel reduction in the annual incidence of HIV infection has been reported. Reductions in morbidity and mortality and improved health-related quality of life have been described in patients undergoing OAMT.The treatment of opioid dependence has been more heavily influenced by moral concepts and prejudices that hinder legislation and interfere with the implementation of OAMT than by scientific evidence. To fulfil public health needs, OAMT should be integrated in harm reduction programmes offered primarily in public facilities, including prisons. Longitudinal studies are needed to detect unmet needs and evaluate programme impact and suitability.
HubMed – Methadone
Human resource development and capacity-building during China’s rapid scale-up of methadone maintenance treatment services.
Bull World Health Organ. 2013 Feb 1; 91(2): 130-5
Li J, Wang C, McGoogan JM, Rou K, Bulterys M, Wu Z
China’s National Methadone Maintenance Treatment Programme (MMT) has expanded from eight clinics serving approximately 1000 clients to 738 clinics that have served more than 340?000 clients cumulatively in only 8 years. This has created an enormous demand for trained providers.Human resource development and capacity building efforts have been conducted in China’s National MMT Programme to create a supply of providers trained in administering MMT for opioid dependence.From 2004 to 2007, China’s National MMT Programme faced several problems: inappropriately low methadone doses, poor compliance, high concurrent drug use and high drop-out rates among clients, and little experience, little training and high turnover rates among providers.Training programmes for individual providers and their trainers were redeveloped and expanded in 2008. Although programme performance metrics show an increase in patients’ annual mean duration in treatment (93 days in 2004 versus 238 days in 2011), the increase in their mean daily methadone dose (from 47.2 mg in 2004 to 58.6 mg in 2011) is modest.Some of the problems that can arise during the development, launch and scale-up of a major national public health effort, such as China’s National MMT Programme, cannot be foreseen. Key to the programme’s success so far have been the strong commitment on the part of China’s government and the optimism and pragmatism of programme managers. Human resources development and capacity-building during scale-up have contributed to improved service quality in MMT treatment clinics and are critical to long-term success.
HubMed – Methadone
Implementing methadone maintenance treatment in prisons in Malaysia.
Bull World Health Organ. 2013 Feb 1; 91(2): 124-9
Wickersham JA, Marcus R, Kamarulzaman A, Zahari MM, Altice FL
In Malaysia, human immunodeficiency virus (HIV) infection is highly concentrated among people who inject opioids. For this reason, the country undertook a three-phase roll-out of a methadone maintenance treatment (MMT) programme. In Phase 3, described in this paper, MMT was implemented within prisons and retention in care was assessed.After developing standard operating procedures and agreement between its Prisons Department and Ministry of Health, Malaysia established pilot MMT programmes in two prisons in the states of Kelantan (2008) and Selangor (2009) – those with the highest proportions of HIV-infected prisoners. Community-based MMT programmes were also established in Malaysia to integrate treatment activities after prisoners’ release.Having failed to reduce the incidence of HIV infection, in 2005 Malaysia embarked on a harm reduction strategy.STANDARD OPERATING PROCEDURES WERE MODIFIED TO: (i) escalate the dose of methadone more slowly; (ii) provide ongoing education and training for medical and correctional staff and inmates; (iii) increase the duration of methadone treatment before releasing prisoners; (iv) reinforce linkages with community MMT programmes after prisoners’ release; (v) screen for and treat tuberculosis; (vi) escalate the dose of methadone during treatment for HIV infection and tuberculosis; and (vii) optimize the daily oral dose of methadone (>?80 mg) before releasing prisoners.Prison-based MMT programmes can be effectively implemented but require adequate dosing and measures are needed to improve communication between prison and police authorities, prevent police harassment of MMT clients after their release, and improve systems for tracking release dates.
HubMed – Methadone
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