Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Communicable Disease Unit, Terengganu Health Department, Kuala Terengganu, Malaysia.
Am J Drug Alcohol Abuse. 2023 Jan 2;49(1):97-108. doi: 10.1080/00952990.2022.2161051. Epub 2023 Feb 14.
In recent years, amphetamine-type-stimulants (ATS) have been extensively misused in South-East Asia, inducing major problems among methadone-maintenance-treatment (MMT) patients. We examine ATS-misuse prevalence and its determinants among MMT patients in East-Coast-Malaysia. A retrospective-observational study was conducted on government-subsidized medication for opioid-use-disorder (MOUD) treatment clinics involving 292 MMT-patients (98% males) who were selected using a multilevel-proportional-stratified random sampling technique. Information obtained during the mandatory monitoring procedure from January 1 to December 31 2019, was utilized to determine ATS misuse prevalence from consecutive random urine drug screening. The determinants associated with its use, namely sociodemographics, social networks, comorbidities, and pharmacological assessments were analyzed via a logistic model. Overall, 52.2% of the MMT-patients (95% CI: 0.42-0.54) had misused ATS at least once during their methadone treatment. These misusing patients were active smokers, hepatitis B and C seronegative, concurrently misused opioids, and had received suboptimum prescribed doses of methadone. Multiple logistic regression analysis demonstrated that the odds of misusing ATS during methadone treatment were 37 times higher among those who concurrently misused opioids (AOR: 37.60, 95% CI: 14.03-100.74) and 12 times higher among those who received suboptimal methadone doses (<60 mg/day) (AOR: 12.24, 95% CI: 5.58-25.43). This study demonstrated the significant prevalence of ATS misuse among MMT-patients in East-Coast-Malaysia, especially among patients who were prescribed suboptimal doses of methadone and/or demonstrated concomitant opioid-misuse. Stringent urine-monitoring is crucial to prevent diversion to ATS misuse. Nonetheless, to avoid negligence and improve physician engagement, the relevant authorities should immediately plan a comprehensive national-standard training module comprising support activities for professional methadone-prescribers.
近年来，安非他命类兴奋剂（ATS）在东南亚被广泛滥用，给美沙酮维持治疗（MMT）患者带来了重大问题。我们考察了东海岸马来西亚 MMT 患者中 ATS 滥用的流行情况及其决定因素。这项回顾性观察研究对参与政府补贴的阿片类药物使用障碍（MOUD）治疗诊所的 292 名 MMT 患者（98%为男性）进行了调查，采用多级比例分层随机抽样技术选择这些患者。使用 2019 年 1 月 1 日至 12 月 31 日期间强制性监测程序中获得的信息，通过连续随机尿液药物筛查来确定 ATS 滥用的流行率。使用逻辑模型分析与 ATS 使用相关的决定因素，包括社会人口统计学、社交网络、合并症和药物评估。总体而言，52.2%的 MMT 患者（95%CI：0.42-0.54）在美沙酮治疗期间至少曾一次滥用过 ATS。这些滥用 ATS 的患者是活跃吸烟者，乙型肝炎和丙型肝炎血清阴性，同时滥用阿片类药物，且接受的美沙酮处方剂量不理想。多变量逻辑回归分析表明，同时滥用阿片类药物的患者在美沙酮治疗期间滥用 ATS 的可能性高 37 倍（比值比：37.60，95%CI：14.03-100.74），接受不适当美沙酮剂量（<60mg/天）的患者高 12 倍（比值比：12.24，95%CI：5.58-25.43）。这项研究表明，东海岸马来西亚 MMT 患者中 ATS 滥用的流行率非常高，特别是在接受不适当美沙酮剂量和/或同时滥用阿片类药物的患者中。严格的尿液监测对于防止转向 ATS 滥用至关重要。然而，为了避免疏忽大意和提高医生的参与度，有关当局应立即制定一个全面的国家标准培训模块，包括对专业美沙酮开处方者的支持活动。
