Opiate Users’ Perceived Barriers Against Attending Methadone Maintenance Therapy: A Qualitative Study in China

Abstract

Methadone maintenance therapy (MMT) in China is facing challenges such as high relapse rates and low coverage. The study assessed factors influencing MMT utilization among opiate users. In-depth interviews were conducted among 30 opiate users in 2008 to ascertain the barriers against seeking MMT. Data were analyzed using ATLAS.ti. Barriers to the treatment included requirement of registration with police, perceived discrimination, logistic difficulties, side effects, fear of being addicted to another drug, lack of additional services, and economic burden. The result suggests the need for structural changes such as improving comprehensive services, simplifying application procedure, and enhancing referral system. The study's limitations are noted.

RÉSUMÉ

Obstacles perçus par les utilisateurs d'opiacés en rapport avec le traitement d'entretien à la méthadone: Etude qualitative réalisée en Chine

Le traitement d'entretien à la méthadone (TEM) en Chine fait face à des défis tels que le taux élevé de rechute et la faible couverture. L’étude a évalué les facteurs influençant l'utilisation du TEM parmi les utilisateurs d'opiacés. Des entrevues en profondeur ont concernée 30 utilisateurs d'opiacés en 2008 pour déterminer les obstacles au TEM. Les données ont été analysées à l'aide d'ATLAS.ti. Les obstacles au traitement comprennent la nécessité d'enregistrement à la police, les discriminations perçues, les difficultés techniques, les effets secondaires, la crainte d’être dépendant à d'autres drogues, le manque de service supplémentaires et la charge économique. Les résultats suggèrent le besoin de changements structurels à savoir l'amélioration des services complets, la simplification de la procédure de souscription et l'amélioration du système de référence.

Mots clés: Traitement d'entretien a la Méthadone, Chine, qualitatif, utilisateurs d'opiacés, VIH/SIDA

RESUMEN

Barreras de Consumidores de Opiáceos Percibida Contra Asistir a la Terapia de Mantenimiento con Metadona: Un Estudio Cualitativo en China

La Terapia de Mantenimiento con Metadona (MMT) en China se enfrenta a retos tales como las tasas de recaida de alta y baja cobertura. El studio evaluó los factores que influyen en la utilizacion de MMT entre los consumidores de opiáceos. Las entrevistas en profundida se realizaron entre los 30 consumidores de opiáceos en 2008 para determiner las barreras contra la búsqueda de MMT. Los datos fueron analizados utilizando ATLAS.ti. Barreras para el tratamiento incluye exigencia de una inscripción con la policia, la discriminación percibida, las dificultades logisticas, los efectos secundarios, el miedo de ser adicto a otra droga, la falta de servicios adicionales, y la carga económica. El resultado sugiere la necesidad de cambios estructurales como la mejora de servicios integrals, la simplificación de trámites de solicitud y la mejora de sistema de referencia.

Palabras Claves: Terapia de Mantenimiento con Metadona, China, cualitativo, los consumidores de opiáceos, el VIH/SIDA

Keywords :

• methadone maintenance therapy
• China
• qualitative
• opiate users
• HIV/AIDS

THE AUTHORS

Dr. Chunqing Lin, Ph.D., received her doctorate degree from the Fogarty International HIV/AIDS training program of University of California, Los Angeles (UCLA). She is currently a project director in the UCLA Semel Institute—Center for Community Health. Dr. Lin has more than 6 years of experience in qualitative and quantitative researches. Her research interests include HIV/AIDS behavioral control and intervention. She has authored and coauthored over 30 articles published in international peer-reviewed journals.

Dr. Zunyou Wu, MD, Ph.D., is making his mark in global health as the director of the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, the highest position for HIV/AIDS control in China. Dr. Wu was the first public health investigator to report the HIV epidemic among former plasma donors in rural China in 1995 and initiated a health promotion program supporting condom use. Dr. Wu was also the first to successfully implement outreach programs for female sex workers through extensive behavioral interventions. He led China's first research project for harm reduction among drug users, and then took a leadership role in scaling up China's national methadone maintenance program. His research sparked the creation of national guidelines in China for sex workers and substance users, translating science into life-saving public health programs. Dr. Wu also serves on committees which oversee HIV intervention projects in Russia, India, Peru, and Zimbabwe, as well as the Task Force on drug use and HIV for UNDCP and UNAIDS in the Asia-Pacific region.

Prof. Roger Detels, MD, MS, is professor and chair of the Department of Epidemiology at the UCLA School of Public Health. He began his research on HIV/AIDS in 1981, with the development of a cohort of homosexual students. Since 1984, he has been the principal investigator of the Los Angeles Center of the Multicenter AIDS Cohort Study, one of the largest natural history studies of HIV/AIDS in the world. For 18 years, he has been the program director of the National Institutes of Health UCLA/Fogarty AIDS International Training and Research Program, which has trained over 110 health professionals from China, India, Brazil, Thailand, Vietnam, Cambodia, Myanmar, Indonesia, the Philippines, and Laos in epidemiology and HIV/AIDS. He has served as a consultant for the World Health Organization and the UNAIDS programs in China, India, Indonesia, and Vietnam; for USAID in the Philippines and Cambodia; the United Nations Development Program in Myanmar; and Family Health International in Cambodia. He has assisted the governments of Thailand, Myanmar, the Philippines, Cambodia, and Indonesia in the development of their HIV sentinel surveillance systems. He has spoken on HIV/AIDS throughout the world and has published over 200 articles on HIV/AIDS from a total of over 400 published articles and chapters on various topics since 1966.