The Cost of Providing Methadone Maintenance Treatment in Ontario, Canada.

Filed under: Methadone Detox

Am J Drug Alcohol Abuse. 2012 Jul 11;
Zaric GS, Brennan AW, Varenbut M, Daiter JM

Objectives: To estimate the cost of providing methadone maintenance treatment in Ontario, Canada, from the perspective of the public payer. Methods: We analyzed a database of all patient clinic visits, laboratory tests for urine toxicology screening, and methadone scripts from a group of methadone clinics in Ontario. The database consisted of patient visits and visit information from 1 January 2003 to 31 December 2009. We estimated the cost of providing methadone maintenance treatment as the sum of physician costs, laboratory costs for urine samples (toxicology screens), methadone costs, and pharmacy costs. Pharmacy costs include dispensing fees and markups. All costs are expressed in 2010 Canadian dollars. Results: The database consisted of 9479 unique patients. The average age on the date of the first recorded visit was 34.3, and among the patients 62.3% were male. There were 6,425,937 patient days of treatment and the total cost of all treatment-related services was approximately $ 99,491,000. The total cost was comprised of physician billing (9.8%), pharmacy costs (39.8%), methadone (3.8%), and performing urine toxicology screens (46.7%). The average cost per day for treatment was $ 15.48, corresponding to $ 5651per year if patients were to remain in treatment continuously. Conclusions: The cost of providing methadone maintenance treatment in Ontario is comparable to estimates from the United States and Australia. Scientific Significance: This information is important to policy makers for planning and budgeting purposes and as part of a full cost-benefit or cost-effectiveness analysis of methadone treatment.
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The dual pathway of professional attitude among health care workers serving HIV/AIDS patients and drug users.

Filed under: Methadone Detox

AIDS Care. 2012 Jul 12;
Shen YM, Lin SR, Chen CL, Huang TM, Huang YH, See LC, Deng FL

Abstract The professional attitude of health care workers (HCWs) who serve HIV/AIDS patients and drug users is important in implementation of the harm reduction program (HRP). This study was to explore the causal relationships between education and training, AIDS-related knowledge, attitude of supporting methadone maintenance treatment (MMT), risk perception, and professional attitude of HCWs toward serving HIV/AIDS patients and drug users. We distributed a self-administered questionnaire to HCWs who have served HIV/AIDS patients and drug users due to work in Taoyuan, northern Taiwan. Structural equation modeling (SEM) was used to test various pathways regarding the professional attitudes of HIV/AIDS patients and drug users among HCWs. A total of 218 HCWs were eligible for this study. The dual pathway model was emerged: (1) have attended education and training courses regarding to HRP positively and significantly affects professional attitude via the attitude of supporting MMT. The correlation (r) was 0.27 between education and training and the attitude of SMMT, and was 0.42 between the attitude of SMMT and professional attitude. (2) AIDS-related knowledge negatively and significantly affects professional attitude via risk perception of contracting HIV. The correlation was -0.22 between AIDS-related knowledge and risk perception, and was -0.25 between risk perception and professional attitude. Various fit indices confirmed a reasonable and acceptable fit of the model. Balance theory and approach-avoidance conflict may partially explain the dual pathways of professional attitude of HCWs toward serving HIV/AIDS patients and drug users. Our result suggests that, among HCWs, education and training courses regarding to HRP are important in increasing the attitude SMMT and AIDS-related knowledge directly, thus, professional attitude serving HIV/AIDS patients and drug users can be enhanced indirectly.
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HIV Infection Risk among Injection Drug Users in a Methadone Maintenance Treatment Program, Taipei, Taiwan 2007-2010.

Filed under: Methadone Detox

Am J Drug Alcohol Abuse. 2012 Jul 11;
Yen YF, Rodwell TC, Yen MY, Hsu YH, Chuang P, Li LH, Su LW, Yang YH, Jiang XR, Fang YC, Garfein RS

Background: Taiwan has a growing HIV/AIDS epidemic that has recently shifted to an increase among injection drug users (IDUs). This study aimed to measure the prevalence and incidence and identify the correlates of HIV infection among IDUs in a large methadone maintenance treatment program (MMTP) in Taipei, Taiwan. Methods: Data from intake interviews and HIV testing completed by IDUs upon admission to the Taipei City Hospital MMTP in 2007-2010 were included in this analysis. HIV testing was repeated semi-annually among maintained clients who were HIV-negative during MMTP admission. Results: Of 1444 IDUs admitted, 85.9% were male, median age was 40 years, and mean years of injecting was 14.3 (range: 1-64). The prevalence of HIV, HCV, and HIV/HCV co-infection was 13.4%, 91.1%, and 13.2%, respectively. In multivariable analysis, HIV infection was associated with sharing syringes during the 6 months prior to admission (OR = 14.76, 95% CI 10.31-21.13), homelessness (OR = 6.46, 95% CI 1.49-28.00), and lifetime number of MMTP admissions (OR = 1.76, 95% CI 1.30-2.38) and times incarcerated (OR = 1.10, 95% CI 1.03-1.18). HIV seroincidence was 1.15/100 person-years at risk (95% CI .62-8.77/100 PY) among IDUs who were HIV-negative at first admission. Conclusions: Taiwanese IDUs in MMTP have a high HIV prevalence, which was associated with syringe sharing and other factors related to social marginalization. Our findings highlight the importance of harm reduction programs, including syringe exchange, along with HIV-prevention education.
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Stercoral Perforation Requiring Subtotal Colectomy in a Patient on Methadone Maintenance Therapy.

Filed under: Methadone Detox

Case Rep Surg. 2012; 2012: 176143
Sakharpe A, Lee YK, Park G, Dy V

Stercoral perforation of the colon is a rare but serious complication of chronic constipation. We present a case of stercoral perforation requiring subtotal colectomy in a 41-year-old female who had been on methadone maintenance for a history of long-term intravenous heroin use. Our case highlights the importance of prompt and thorough surgical intervention in the successful treatment of this rare condition.
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