Predictors for Dropping-Out From Methadone Maintenance Therapy Programs Among Heroin Users in Southern Taiwan

Abstract

This study examined the methadone maintenance therapy (MMT) retention rates of heroin users in Taiwan and the predictors for dropout in the 18-month period after starting MMT. We consecutively recruited 368 intravenous heroin users receiving MMT in 2007–2008 and applied Cox proportional hazards regression analysis to determine the predictive effect of pre- and in-treatment variables on early discontinuation of MMT. The retention rate at 18 months was 32.3%. High heroin expenses, more severe harm caused by heroin use, perceived lower family support, and lower methadone dosage at 3 months after starting MMT increased the risk of dropout in the follow-up period.

RÉSUMÉ

Prédicteurs pour Drop-outs de la Méthadone Programmes Traitement d'entretien chez les Héroïnomanes dans le sud de Taiwan

Titre courant: Prédicteurs de Traitement d'entretien à la Méthadone Drop-out

Cette étude a examiné les programme de traitement d'entretien à la méthadone (PTEM) d'usagers d'héroïne à Taiwan et les prédicteurs de l'abandon dans la période de 18 mois après le début du PTEM. Nous recrutés consécutivement 368 utilisateurs d'héroïne par voie intraveineuse recevant le PTEM et appliquées de régression de Cox des risques afin de déterminer l'effet prédictif de prétraitements et en variables sur l'arrêt précoce de la PTEM. Le taux de rétention à 18 mois était de 32,3%. Les frais élevés d'héroïne, des dommages plus importants causés par la consommation d'héroïne, perçue de soutien familial plus faible et plus faible dose de méthadone à 3 mois après le début du PTEM augmentait le risque de décrochage dans la période de suivi.

Mots clés: héroïne, dépendance à l'héroïne, la réduction des méfaits, le traitement d'entretien à la méthadone, rétention.

RESUMEN

Título: Factores de riesgo del abandono de las Terapias con Programas de Mantenimiento con Metadona entre consumidores de heroína en el sur de Taiwán

Subtítulo: Predictores del abandono de los Programas de Mantenimiento con Metadona

Para este estudio se han examinado las tasas de retención de los programas de Terapia de Mantenimiento con Metadona (TMM) entre los consumidores de heroína en Taiwán y los factores de riesgo de abandono en el período de 18 meses después de comenzar la TMM. Se han reclutado consecutivamente 368 consumidores de heroína por vía intravenosa que recibieron TMM y se ha aplicado el análisis de regresión de Cox, de los riesgos proporcionales, para determinar el efecto predictivo de las variables que afectan antes y durante el tratamiento en la interrupción temprana de la TMM. La tasa de retención a los 18 meses fue del 32,3%. Los altos costes de heroína, el grave daño causado por el consumo de heroína, la percepción de escaso apoyo familiar y una menor dosis de metadona a los 3 meses después de comenzar TMM aumentan el riesgo de abandono en el período de seguimiento.

Palabras clave: heroína, dependencia de la heroína, reducción de daños, la terapia de mantenimiento con metadona, Retención.

Keywords :

• Harm reduction
• heroin dependence
• heroin
• methadone maintenance therapy
• retention

Notes

3 The reader is reminded that the concepts of “risk factors,” as well as “protective factors,” are often noted in the literature, without adequately noting their dimensions (linear, nonlinear; rates of development; anchoring or integration, cessation, etc.), their “demands,” the critical necessary conditions (endogenously as well as exogenously; from a micro to a meso to a macro level), which are necessary for either of them to operate (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to and whether their underpinnings are theory-driven, empirically-based, individual and/or systemic stake holder- bound, based upon “principles of faith,” historical observation, precedents and traditions that accumulate over time, conventional wisdom, perceptual and judgmental constraints, “transient public opinion,” or what. It is necessary to consider and to clarify if these terms are not to remain as yet additional shibboleth in a field of many stereotypes, tradition-driven activities, “principles of faith” and stakeholder objectives. Editor's note.

4 The reader is reminded that the focus of drug user dropping out of treatment research has been and continues to be the drug user and selected demographics without considering the quality of the treatment, as well as “therapist” and program factors. The interested reader is referred to: Magura, S.(ed.) Special Issue on Program Quality In Substance Dependency Treatment, (2000), SUM, 34:12–14) Editor's note.

5 Treatment can be briefly and usefully defined as a unique, planned, goal directed, temporally structured, multidimensional change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into profession-based, tradition-based, mutual-help-based (AA,NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—that are not also used with nonsubstance users. Whether or not a treatment technique is indicated or contra-indicated, and its selection underpinnings (theory-based, empirically-based, principle of faith-based, tradition-based, etc.) continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) and wellbeing treatment-driven models there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success as well as failure. Treatment is implemented in a range of environments; ambulatory as well as within institutions that can include controlled environments. Treatment includes a spectrum of clinician-caregiver-patient relationships representing various forms of decision-making traditions/models: (1) the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive; (2) shared decision-making that facilitates the collaboration between clinician and patient(s) in which both are active; and (3) the “informed model” in which the patient makes the decision(s). Editor's note.

6 The reader is referred to Hills's criteria for causation, which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. [Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine 58: 295–300]. Editor's note.