Barriers to retention in methadone maintenance therapy among people who inject drugs in Bangkok, Thailand: a mixed-methods study
Barriers to retention in methadone maintenance therapy among people who inject drugs in Bangkok, Thailand: a mixed-methods study
复制标题
DOI：
10.1186/s12954-017-0189-3
复制
发表时间：
2017-09-07
影响因子：
4.4
通讯作者：
Kerr, Thomas
中科院分区：
文献类型：
--
作者：
Hayashi, Kanna;Ti, Lianping;Kerr, Thomas
背景：美沙酮维持治疗（MMT）是治疗阿片类药物使用障碍以及预防和管理注射吸毒者（PWID）艾滋病毒的主要手段。虽然之前的研究表明泰国注射吸毒者中美沙酮的剂量较低且终止 MMT 的比例较高，但人们对这种情况下患者使用 MMT 的生活经历知之甚少。因此，我们进行了一项混合方法研究，以考察泰国曼谷吸毒者保留 MMT 的障碍，特别关注美沙酮剂量。方法：使用双变量统计分析从 2011 年 7 月至 10 月期间从接受美沙酮治疗的吸毒者收集的定量调查数据。对 2011 年 7 月至 2012 年 6 月期间对 16 名接受美沙酮治疗的吸毒者进行半结构化访谈收集的定性数据进行了主题分析，重点关注个人层面、社会结构和环境方面获取 MMT 的障碍。结果：在 158 名调查参与者中，美沙酮的中位剂量为 30 毫克/天（四分位数范围 20-50）。其中，15.8% 的人报告称由于美沙酮处方剂量过低而在街头获得美沙酮，19.0% 的人报告称最近共用注射器。定性访谈数据显示了一些与美沙酮提供者相关的障碍，包括由于美沙酮是西药而阻止患者使用美沙酮、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（在某些情况下涉及提供非药物“糖浆”）。阻碍最佳 MMT 获取的社会结构和环境障碍包括警方对美沙酮诊所的严密监视；结论：在我们接受美沙酮治疗的吸毒者样本中，根据国际指南，美沙酮剂量不理想。需要解决阿片类激动剂治疗国际指南遵守不力、执法严厉以及监狱中缺乏美沙酮的问题，以优化 MMT 并减少泰国与未经治疗的阿片类药物使用障碍相关的危害。
Background: 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.Methods: 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.Results: 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.Conclusions: 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.