British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
Harm Reduct J. 2017 Sep 7;14(1):63. doi: 10.1186/s12954-017-0189-3.
Methadone maintenance therapy (MMT) is a mainstay for treating opioid use disorder and preventing and managing HIV among people who inject drugs (PWID). While previous research suggested low dosing of methadone and high rates of discontinuation of MMT among PWID in Thailand, little is known about patients' lived experiences with MMT in this setting. Therefore, we conducted a mixed-methods study to examine barriers to retention in MMT among PWID in Bangkok, Thailand, with particular attention to methadone dosing.
Bivariate statistics were used to analyze quantitative survey data collected from methadone-treated PWID between July and October 2011. Qualitative data collected through semi-structured interviews with 16 methadone-treated PWID between July 2011 and June 2012 were analyzed thematically, with a focus on individual-level, social-structural, and environmental barriers to accessing MMT.
Among 158 survey participants, a median dosage of methadone was 30 mg/day (interquartile range 20-50). Of these, 15.8% reported having acquired street methadone due to low prescribed dosages of methadone and 19.0% reported recent syringe sharing. Qualitative interview data indicated some methadone provider-related barriers, including discouraging patients from using methadone due to it being a Western medicine, difficulty negotiating higher doses of methadone, and abrupt dose reductions without patient consultation (involving the provision of non-medicated "syrup" in some cases). Social-structural and environmental barriers to optimal MMT access included intense police surveillance of methadone clinics; and frequent incarceration of PWID and a lack of access to methadone in prisons.
Among our sample of methadone-treated PWID, methadone dosages were suboptimal according to the international guidelines. Poor adherence to international guidelines for opioid agonist therapies, aggressive law enforcement, and a lack of methadone in prisons need to be addressed to optimize MMT and reduce harms associated with untreated opioid use disorder in Thailand.
美沙酮维持治疗（MMT）是治疗阿片类药物使用障碍和预防及管理注射吸毒者（PWID）中艾滋病毒的主要方法。尽管之前的研究表明，泰国的 PWID 中接受美沙酮治疗的患者美沙酮剂量较低，且中断 MMT 的比例较高，但对于该人群在这一环境下对 MMT 的实际体验知之甚少。因此，我们开展了一项混合方法研究，以调查曼谷 PWID 中接受美沙酮治疗的患者在 MMT 中的保留率障碍，尤其关注美沙酮的剂量。
我们使用了定量调查数据进行了单变量分析，该数据于 2011 年 7 月至 10 月期间从接受美沙酮治疗的 PWID 中收集。我们还对 16 名接受美沙酮治疗的 PWID 进行了半结构式访谈，于 2011 年 7 月至 2012 年 6 月期间收集定性数据，并对获取 MMT 的个人层面、社会结构层面和环境层面的障碍进行了主题分析。
在 158 名调查参与者中，美沙酮的中位数剂量为 30mg/天（四分位距 20-50）。其中，15.8%的人因美沙酮的规定剂量低而获得街头美沙酮，19.0%的人报告最近共用过注射器。定性访谈数据表明存在一些与美沙酮提供者相关的障碍，包括由于美沙酮是一种西药而劝阻患者使用美沙酮、难以协商更高剂量的美沙酮，以及未经患者咨询而突然减少剂量（在某些情况下提供非药物性“糖浆”）。获取最佳 MMT 的社会结构和环境障碍包括美沙酮诊所受到的严密警察监视；PWID 经常被监禁，以及监狱内缺乏美沙酮。
在我们接受美沙酮治疗的 PWID 样本中，美沙酮的剂量不符合国际指南。需要解决不符合阿片类激动剂治疗国际指南、执法力度大以及监狱内缺乏美沙酮的问题，以优化 MMT，并减少泰国未经治疗的阿片类药物使用障碍相关的危害。
