Nong Thuong, Capoccia Victor, Mulvey Kevin P
The Heller School for Social Policy and Management, Brandeis University, 415 South St MSC 035, Waltham, MA 02453, United States of America.
Vineyard Haven, MA, 02568, United States of America.
J Subst Abuse Treat. 2022 Mar;134:108401. doi: 10.1016/j.jsat.2021.108401. Epub 2021 Apr 14.
Vietnam made progress transitioning from a criminal justice to a health treatment response for substance use disorders (SUD) in recent years. This case study describes the evolution of Vietnam's SUD treatment system from 2005 to 2020 to understand and learn from the phases of its development. The case study is based on data from a predesigned interview guide for 47 respondents, literature and policy desk review and direct experience of the authors. Vietnam saw remarkable growth of opioid use disorder (OUD) treatment from 2005 when methadone was unavailable, to 2020 with 335 methadone clinics in all 63 provinces serving more than 52,200 patients. The growth in OUD treatment accounts for much of Vietnam's success managing its HIV epidemic for which injection drug use was a major vector. An unintended consequence, however, focused only on OUD as a strategy to address HIV and was unable to address multiple substances. Most elements of a modern evidence and community-based SUD treatment system exist in Vietnam; however, they are siloed and influenced by multiple government administrative jurisdictions. Faced with rising amphetamine and persistent alcohol use, the path ahead for Vietnam involves a choice between a reliance on compulsory rehabilitation centers or a plan to broaden the scope of substances and treatments, and further integrate with Vietnam's commune-based primary health system.
近年来，越南在从刑事司法应对转向对物质使用障碍（SUD）的健康治疗应对方面取得了进展。本案例研究描述了越南SUD治疗系统在2005年至2020年期间的演变，以了解其发展阶段并从中学习。该案例研究基于针对47名受访者预先设计的访谈指南中的数据、文献和政策案头审查以及作者的直接经验。越南的阿片类物质使用障碍（OUD）治疗从2005年美沙酮尚未可得时显著增长，到2020年在所有63个省份拥有335家美沙酮诊所，为超过52,200名患者提供服务。OUD治疗的增长在很大程度上解释了越南在控制艾滋病毒疫情方面的成功，注射吸毒是艾滋病毒传播的主要途径。然而，一个意外的后果是，仅将OUD作为应对艾滋病毒的战略，无法解决多种物质问题。越南存在现代循证和基于社区的SUD治疗系统的大多数要素；然而，它们相互孤立，受到多个政府行政管辖部门的影响。面对苯丙胺使用的增加和持续的酒精使用问题，越南未来的道路涉及在依赖强制康复中心和扩大物质及治疗范围并进一步与越南基于公社的初级卫生系统整合的计划之间做出选择。
