Context: Modifiable risk factors in older methadone maintenance treatment (MMT) patients may put them at a greater risk of acquiring chronic diseases. The paucity of literature regarding the well-being and service needs of older MMT patients required investigation to determine whether these patients are treated for and adhere to chronic disease medications(s) comparably to those not on MMT. Objective: This study compared the proportion of MMT patients to a matched control group treated with first-line medications for four chronic diseases: hypertension, chronic obstructive pulmonary disease (COPD), diabetes mellitus and depression. As a secondary outcome measure, this study also examined the adherence comparability between the two groups. Method: This case control study used prescription claims data from the BC Ministry of Health’s PharmaNet database from October 1, 2008 to December 31, 2009. Each MMT patient was individually matched with a control subject in terms of age, sex, social assistance coverage and local health area. Both groups consisted of 143 men and 56 women for a total of 400 participants. Persons 50 years of age and older, residents of BC, and had prescriptions filled during October 1, 2008 to December 31, 2009, were randomly selected from the PharmaNet database. Results: Odds ratios (ORs) were calculated to compare the odds of MMT patients to non-MMT patients on a first-line medication for each chronic disease under investigation. ORs were 0.865 for hypertension (ns), 0.738 for diabetes (ns) and 4.176 for depression (p <0.001). For COPD the OR could not be calculated as no controls were treated for COPD; however, 11.6% of the MMT group were prescribed COPD medications which was significantly higher than the controls (p<.001). Adherence was calculated using continuous measures of medication availability (CMA) “by patient” and “by medication class” during patients’ persistent periods (continuous use periods) CMA(1), as well as the entire study period CMA(2). By patient, the mean CMA(1) showed no difference between the groups (non-MMT group: 91.9%, SD=15.8, CI=95% vs MMT group: 89.7%, SD=22.2, CI=95%). The mean CMA(2) was statistically different (p<0.05) between the groups (non-MMT group: 70.5%, SD=25.3, CI=95% vs MMT group: 60.8%, SD=29.1, CI=95%). By medication class, CMA(1) was 80-100% for most medication classes for both groups except for insulins and inhalers in the MMT group which fell between 40-79%. The CMA(2) for most medication classes was 60-86% in the non-MMT group and 30-76% in the MMT group. However, the differences between the groups were not statistically significant. Conclusion: Odds ratios for the treatment of all four chronic diseases differed. Therefore, looking at each chronic disease separately may be worthwhile to suggest potential targets for intervention. Disease-specific tailored interventions related to lifestyle risk factors, comorbid medical conditions, and adherence to chronic medications could potentially improve the overall health of older MMT patients. However, development of appropriate interventions and treatments requires research that properly recognizes the physical and mental health problems faced by older MMT patients (Rosen, Hunsaker, Albert, Cornelius, & Reynolds III, 2010). / Graduate

Indonesia has been implementing methadone maintenance treatment (MMT) since January 2003 as a strategy to minimize HIV transmission among injecting drug users (IDU). Previous studies have shown the effectiveness of the program and also showed that the program had attracted many IDU to participate. However, the dropout rate, particularly in Jakarta clinics, was relatively high. The first aim of this study was to investigate the MMT retention rate and its predictive variables. The second aim was to examine the effects of remaining in the program on treatment outcomes. A six-month longitudinal prospective cohort study was conducted at the client level and a cross-sectional survey was carried out at the clinic level. Information from this study provides significant inputs for developing drug treatment policy and improving its quality of service in Indonesia. It also contributes to a better understanding of the substitution treatment implementation in Indonesia. The average 3-month treatment retention rate was 74.2 percent and the 6-month retention rate was 61.3 percent. There was no significant difference in retention rates between clinics. Significant predictors of treatment retention in MMT in Indonesia were size of dose, the interaction between take-home dose and clinic experience, age of participant, participant’s belief towards the program and perceived accessibility, while a variable representing perceived peer support unexpectedly predicted an increased likelihood of prematurely leaving the treatment. This study showed a marked reduction in the use of heroin and depression status and a significant improvement of self-efficacy at the follow up times among participants who continued in treatment. There were no significant differences in criminal involvement and physical health status between those who remained in treatment and the treatment dropouts in both follow-up interviews. Nevertheless, there was a significant improvement in physical health from baseline to follow-up in both groups. The study concluded that retention rates of MMT in Indonesia were comparable to those of similar programs in other countries. As previously reported in other settings, dose was the primary predictor of treatment retention in Indonesia. A policy of providing take-home doses, prescribed in experienced clinics,was also found to be a significant predictor of remaining in treatment. Further research, however, is still needed to explain some of the unexpected observations. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1522114 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2010

Background: Methadone maintenance treatment (MMT) is a commonly prescribed therapy for patients with opioid use disorder, yet inter-individual variability in terms of treatment response is evident. Given the high prevalence of cannabis use in this population, this thesis aims to elucidate the association between cannabis use and MMT outcomes. Methods: We conducted a systematic review and meta-analysis to comprehensively evaluate the literature and quality of evidence, as well as to identify gaps in the literature to inform future research. We then conducted a cross-sectional study investigating sex differences in the association between cannabis use and illicit opioid use in MMT patients. We employed a multivariable logistic regression analysis to assess the influence of any cannabis use as well as heaviness of cannabis use within men and women. Results: The systematic review included 22 observational studies. Results revealed the low quality of available evidence as well as substantial heterogeneity among studies. We identified several limitations in the evidence base including reliance on crude measures of cannabis use and inadequate consideration of confounding variables. Our cross-sectional study included a sample of 777 patients on MMT. Consistent with previous research, we found cannabis use to be unrelated to illicit opioid use in the entire sample. However when we stratified the analysis by sex, we found cannabis use was associated with increased odds of having concurrent illicit opioid use. Conclusion: Results of this thesis suggest certain populations within MMT patients may be at higher risk of experiencing adverse effects of cannabis in terms of treatment outcomes. Future work can build on the results of these studies to identify unique risk factors for patients in order to inform the use of tailored treatment options to improve MMT effectiveness. / Thesis / Master of Science (MSc)

Wong, Ngai Sze. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 177-190). / Abstracts in English and Chinese. / ABSTRACT --- p.I / 論文摘要 --- p.II / ACKNOWLEDGEMENT --- p.III / TABLES OF CONTENTS --- p.V / LIST OF ACRONYMS --- p.IX / LIST OF TABLES --- p.X / LIST OF FIGURES --- p.XI / LIST OF APPENDICES --- p.XIII / Chapter CHPATER 1 --- INTRODUCTION --- p.1 / Chapter 1.1. --- BACKGROUND & CONTEXT --- p.2 / Chapter 1.1.1. --- Methadone Maintenance Treatment --- p.2 / Chapter 1.1.1.1. --- Definition of Methadone Maintenance Treatment --- p.2 / Chapter 1.1.1.2. --- The Role of Methadone Maintenance Treatment --- p.3 / Chapter 1.1.1.3. --- Methadone Maintenance Treatment in Hong Kong --- p.4 / Chapter 1.1.2. --- Utilization of Methadone Treatment --- p.6 / Chapter 1.1.2.1. --- Definition of Utilization --- p.6 / Chapter 1.1.2.2. --- Utilization Study in Methadone Treatment --- p.8 / Chapter 1.1.3. --- Geographic Information System Application --- p.10 / Chapter 1.2. --- STUDY AREA --- p.12 / Chapter 1.3. --- RATIONALE & SIGNIFICANCE OF STUDY --- p.15 / Chapter 1.4. --- RESEARCH QUESTIONS --- p.17 / Chapter 1.5. --- RESEARCH OBJECTIVES --- p.18 / Chapter 1.6. --- STUDY PROCEDURES --- p.21 / Chapter 1.7. --- STRUCTURE OF THE STUDY --- p.23 / Chapter CHAPTER 2 --- LITERATURE REVIEW OF METHADONE TREATMENT UTILIZATION STUDY --- p.25 / Chapter 2.1 --- METHADONE TREATMENT UTILIZATION STUDIES --- p.26 / Chapter 2.1.1 --- Individual Determinants --- p.27 / Chapter 2.1.1.1 --- Predisposing Factors --- p.27 / Chapter 2.1.1.1 --- Enabling Factors --- p.29 / Chapter 2.1.1.2 --- Illness Level --- p.31 / Chapter 2.1.2 --- Health Service System --- p.35 / Chapter 2.1.2.1 --- Resource --- p.35 / Chapter 2.1.1.1 --- Organization --- p.36 / Chapter 2.2 --- ANALYSIS METHODS IN METHADONE TREATMENT UTILIZATION STUDIES --- p.40 / Chapter 2.2.1 --- Common Measures --- p.40 / Chapter 2.2.2 --- Study Approach --- p.41 / Chapter 2.2.3 --- Analysis Methods --- p.42 / Chapter 2.2.4 --- Geographic Information System --- p.43 / Chapter 2.3 --- METHADONE TREATMENT UTILIZATION STUDY IN HONG KONG --- p.44 / Chapter 2.4 --- SUMMARY OF LITERATURE REVIEW --- p.45 / Chapter CHAPTER 3 --- METHODOLOGY --- p.46 / Chapter 3.1. --- DEFINITION OF UTILIZATION AND LOCAL UTILIZATION --- p.47 / Chapter 3.2. --- CONCEPTUAL FRAMEWORK FOR MMT UTILIZATION --- p.50 / Chapter 3.2.1. --- Framework Selection --- p.50 / Chapter 3.2.2. --- Components of Andersen & Newman，s Framework for Health Service Utilization --- p.52 / Chapter 3.3. --- DATA SOURCE --- p.54 / Chapter 3.3.1. --- Official Data --- p.55 / Chapter 3.3.2. --- Survey --- p.56 / Chapter 3.3.3. --- Interviews --- p.57 / Chapter 3.3.4. --- Case Study-Survey in a Methadone Clinic in Tai Po --- p.57 / Chapter 3.3.4.1. --- Survey Subject --- p.57 / Chapter 3.3.4.2. --- Rationale for the Survey --- p.58 / Chapter 3.3.4.3. --- Sampling Methods --- p.59 / Chapter 3.3.4.4. --- Questionnaire Design --- p.61 / Chapter 3.3.5. --- Digitized Maps --- p.62 / Chapter 3.4. --- DATA PROCESSING AND MANAGEMENT --- p.63 / Chapter 3.4.1. --- District Utilization and Local Utilization Calculation --- p.63 / Chapter 3.4.2. --- Questionnaire Data Processing --- p.63 / Chapter 3.4.2.1. --- Data Entry & Coding --- p.63 / Chapter 3.4.2.2. --- Digitizing a GIS Layer --- p.64 / Chapter 3.4.2.3. --- Estimated Location of User Home --- p.64 / Chapter 3.4.2.4. --- Sufficiency Level --- p.67 / Chapter 3.4.3. --- Database Management --- p.68 / Chapter 3.5. --- TECHNIQUES TO ANALYZE DATA --- p.70 / Chapter 3.5.1. --- Descriptive Analysis for Spatiotemporal Utilization Pattern --- p.70 / Chapter 3.5.2. --- Quantitative Analysis for Factor Exploration --- p.70 / Chapter 3.5.2.1. --- Assumptions for Correlation and Regression Analysis --- p.70 / General Assumptions --- p.70 / Data Assumptions --- p.72 / Factor Assumptions --- p.73 / Chapter 3.5.2.2. --- Factors Included in the Study Framework --- p.74 / Societal Determinants --- p.75 / Health Services System --- p.76 / Individual Determinants --- p.78 / Chapter 3.5.2.3. --- Pearson´ةs Correlation --- p.80 / Chapter 3.5.2.4. --- Multiple Stepwise Linear Regression --- p.81 / Chapter 3.5.3. --- Quantitative Analysis for Spatial Factor Study --- p.84 / Chapter 3.5.3.1. --- Catchments --- p.84 / Chapter 3.5.3.2. --- Spatial Autocorrelation --- p.89 / Chapter 3.5.4. --- Curve Estimation --- p.90 / Chapter 3.6. --- GIS Customized Tools --- p.90 / Chapter 3.6.1. --- GIS System Literature Review --- p.90 / Chapter 3.6.2. --- Customized Tools Design --- p.92 / Chapter CHAPTER 4 --- ANALYSIS OF MMT UTILIZATION: A CASE STUDY IN HONG KONG … --- p.95 / Chapter 4.1. --- GENERAL DESCRIPTION --- p.96 / Chapter 4.2. --- HEROIN ADDICTION IN HONG KONG --- p.98 / Chapter 4.2.1. --- Spatiotemporal Pattern of Heroin Addiction --- p.98 / Chapter 4.2.2. --- Characteristics of Heroin Users in Hong Kong --- p.103 / Chapter 4.3. --- MMT USERS IN HONG KONG --- p.107 / Chapter 4.3.1. --- Characteristics of Methadone Clinics --- p.107 / Chapter 4.3.2. --- Characteristics of MMT Users --- p.108 / Chapter 4.3.2.1. --- Predisposing Factors of MMT Users --- p.108 / Chapter 4.3.2.2. --- Spatial movement of MMT user --- p.108 / Chapter 4.3.2.3. --- Clinic Environment-Gathering Place --- p.108 / Chapter 4.3.2.4. --- Unique Clinics --- p.109 / Chapter 4.3.3. --- Spatiotemporal Patterns of MMT Users --- p.110 / Chapter 4.4. --- INDIVIDUAL UTILIZATION STUDY - SURVEY IN A METHADONE CLINIC IN TAIPO --- p.114 / Chapter 4.4.1. --- Methadone Clinic Users in Tai Po --- p.114 / Chapter 4.4.2. --- Characteristics of Respondents --- p.114 / Chapter 4.4.2.1. --- Demographic Characteristics --- p.114 / Chapter 4.4.2.2. --- Utilization Level --- p.115 / Chapter 4.4.2.3. --- Spatial Factors and Distribution --- p.116 / Chapter 4.4.3. --- Factors Affecting the Utilization of Tai Po Methadone Clinic --- p.120 / Chapter 4.5. --- CATCHMENTS OF METHADONE CLINICS IN HONG KONG --- p.122 / Chapter 4.5.1. --- Voronoi polygons --- p.123 / Chapter 4.5.2. --- Network Analysis based on travel time --- p.124 / Chapter 4.5.2.1. --- Catchments of Methadone Clinic in Tai Po --- p.125 / Chapter 4.5.2.2. --- Projected Catchments for All Clinics in Hong Kong --- p.126 / Chapter 4.6. --- SPATIOTEMPORAL PATTERN AND SPATIAL RELATIONS OF MMT UTILIZATION --- p.128 / Chapter 4.6.1. --- MMT Utilization --- p.128 / Chapter 4.6.2. --- MMT Local Utilization --- p.131 / Chapter 4.6.3. --- Spatial Relations of MMT Utilization --- p.133 / Chapter 4.7. --- PREDICTORS OF MMT UTILIZATION AND LOCAL UTILIZATION --- p.134 / Chapter 4.7.1. --- Health Care Systems --- p.135 / Chapter 4.7.1.1. --- Resource --- p.135 / Operating Hours --- p.135 / Nearest clinic distance --- p.137 / Distance between a clinic and its nearest clinic in other districts --- p.138 / Chapter 4.7.1.2. --- Accessibility --- p.138 / Chapter 4.7.2. --- Individual Determinants --- p.139 / Chapter 4.7.2.1. --- Predisposing Determinants --- p.140 / Age --- p.140 / Gender --- p.140 / Education --- p.141 / Chapter 4.7.2.2. --- Behavioral Determinant´ؤInjection --- p.141 / Chapter 4.8. --- FUTURE MMT UTILIZATION IN HONG KONG --- p.143 / Chapter 4.9. --- SERVICE GAPS --- p.144 / Chapter 4.10. --- SUMMARY OF STUDY RESULTS --- p.152 / Chapter CHAPTER 5 --- DISCUSSION --- p.153 / Chapter 5.1. --- DISCUSSIONS ON THE RELEVANCE OF UTILIZATION PREDICTORS --- p.154 / Chapter 5.2. --- DISCUSSIONS ON METHADONE CLINIC CLOSURE --- p.159 / Chapter 5.3. --- RESEARCH LIMITATION --- p.164 / Chapter 5.3.1. --- Data Limitation --- p.164 / Chapter 5.3.2. --- Time & Resource Limitation --- p.165 / Chapter 5.3.3. --- Technical Limitation --- p.165 / Chapter 5.4. --- RECOMMENDATIONS --- p.167 / Chapter 5.4.1. --- Recommendations for Methadone Treatment System --- p.167 / Chapter 5.4.2. --- For the Society --- p.169 / Chapter 5.4.3. --- For Further Study --- p.172 / Chapter CHAPTER 6 --- CONCLUSION --- p.174 / BIBLIOGRAPHY --- p.177 / APPENDICES --- p.191

published_or_final_version / Public Administration / Master / Master of Social Sciences

Thesis (Ph.D.)--University of Melbourne, Dept. of Medicine, Western Hospital, 2007. / Typescript. Includes bibliographical references (leaves 145-181).

Background: The theme of the position and experiences of pregnant women in the context of methadone maintenance treatment has not yet been thoroughly examined, the aim was to contribute to break the taboo concerning this topic and help to destigmatize these women. Goals: To map the situation of pregnant women in MMT and to alert to therapeutic specificity of these women. Methods: Semi-structured interview and analysis of the medical documentation were used to obtain the data, observation method, qualified estimate and clinical case reports. Data were processed through content analysis. File: The research group consists of 7 patients who were treated in the Department of Adictology 1st Faculty of Medicine, Charles University and General University Hospital in Prague, who gave birth to at least one child between 2004 and 2014. Results: The analysis shows that during their pregnancy women reduce the use of illicit drugs and tobacco. Despite these pregnancies are usually not planned, it was observed that in these women the pregnancy occured in a situation when the respondents were stabilized in both the treatment and in their social situation. The experience of pregnancy played a stimulating role for dose reduction or direction to abstinence. The reasons are usually the confrontation with the NAS of their child...

The consequences of drug use and benefits of methadone maintenance therapy (MMT) were investigated in a random sample of Maori and non- Maori injecting drug users in Christchurch, Aotearoa New Zealand. Eighty- five injecting drug users (IDUs) who had been on MMT for a mean time of 57 months were interviewed and followed up over an average 18 month period. Markov models were used to model cohorts of IDUs, changes in their health states and the effects of MMT and anti-viral therapy on morbidity and mortality. The savings in life from reductions in drug overdoses were used as the main outcome measure in cost-effectiveness analysis. Cost-utility and cost-benefit analysis were also used to provide additional information on the costs and outcomes of treatment. Comparisons were made between: (a) MMT alone; (b) MMT provided with conventional combination therapy for hepatitis C virus (HCV); and (c) MMT provided with anti-viral therapy with pegylated interferon. The monetary costs of drug use and benefits of MMT were similar for Maori and non-Maori. However, Markov modelling indicated that MMT is associated with greater savings in life for Maori than for non-Maori. Further, Maori IDUs identified the main personal costs of drug use as being loss of their children and loss of marriage or partners. Large reductions in use of opioids and benzodiazipines were reported at interview, compared with before starting MMT. The participants also reported large reductions in crime and stabilisation of their lifestyles. Improvements in the general health of IDUs om MMT were reported. However, 89% were positive for HCV infection, which was identified as the major physical health problem affecting IDUs in New Zealand. Few IDUs had received anti-viral therapy for HCV infections, despite having stabilised on MMT. This study investigated the benefits of providing anti-viral therapy for HCV to all patients meeting treatment criteria. The cost-effectiveness of MMT alone was estimated at $25,397 per life year saved (LYS) for non- Maori men and $25,035 for non-Maori women IDUs (costs and benefits discounted at 3%). The incremental effects of providing anti-viral therapy for HCV to all eligible patients were to save extra years of life, as well as to involve additional costs. The net effect was that anti-viral therapy could be provided, at a similar level of cost-effectiveness, to all patients who meet HCV treatment criteria. Cost-effectiveness could be improved if IDUs could be stabilised on MMT five years earlier at an average age of 26 instead of the current age of 31 years. The cost-effectiveness of treatment with pegylated interferon was similar to that for conventional combination therapy because there were incremental savings in life as well as increased treatment costs. Costs per LYS were estimated to be lower for Maori than for non-Maori, reflecting ethnic differences in mortality. Sensitivity analysis revealed that provision of MMT with anti-viral treatment remained cost-effective under varying assumptions of mortality, disease progression and compliance with treatment. the main problems that were not improved during MMT were continuing use of tobacco and cannabis, low participation in paid employment, only three participants had received specific treatment for their HCV infections. Cost-benefit analysis using a conservative approach showed a ratio of the benefits to the costs of MMT of 8:1. Benefits were demonstrated in terms of large reductions in crime. Benefit to cost ratios were similar for the different policy examined, as well as for both Maori and non-Maori IDUs.

Addiction to opiates is a complex public health issue affecting thousands of Canadians. Methadone Maintenance Treatment (MMT) is considered the gold standard in Canada, and the world, for treating opiate dependence. In the past, Canadian research into opiate addiction and the effectiveness of MMT has mostly focused on larger cities: Toronto, Montreal, and Vancouver. This community based research study employed a mixed method approach to gain understanding of the experiences and satisfaction with MMT and other health services available to opiate users in Belleville, Ontario (population 48,000). Surveys (N = 53), focus groups, participant-observation methods and key informant interviews were used to gather data. The results provide an overall picture of the quality of life for opiate users and MMT clients, the quality of care clients receive, and the perceptions of community members regarding MMT. Challenges related to smaller locales are identified along with recommendations for improving MMT health services. / UOIT

The methadone maintenance treatment population suffers from high rates of comorbid psychiatric and substance use disorders. Despite a more than 40-year treatment history, not all patients are satisfied with methadone treatment and more than half of the patients complain of significant inter-dose withdrawal at least some of the time. The objectives of this research were to investigate the pharmacological response to methadone under the influence of comorbid major depressive disorder and smoking; and to identify factors other than physical withdrawal symptoms that can differentiate patients based on their complaints of dissatisfaction with treatment. In Study 1, seven depressed methadone maintenance patients experienced more opioid withdrawal symptomatology over a 24-hour methadone-dosing interval than 10 nondepressed methadone patients. Depression severity was significantly correlated with trough opioid withdrawal severity. This suggests that depression or depressive symptoms are related to reported opioid withdrawal. In Study 2, many factors other than physical opioid withdrawal symptoms were able to differentiate patients who were satisfied with treatment (holders, n=25), partially satisfied with treatment (partial holders, n=35), and not satisfied with treatment(nonholders, n=30). Results suggested that these patient satisfaction groups cluster differently depending on physical opioid withdrawal, mood, psychological distress, and personality. Nonholders experienced more physical withdrawal symptoms, craving for opioids, and negative drug effects. Holders had less psychological distress and experienced less negative mood states than the other groups. Partial holders had less agreeable personalities compared to patients in the other groups. In Study 3, opioid and nicotine withdrawal symptoms and effects were measured in 40 methadone-maintained patients who were current smokers during trough and peak methadone effects, both pre and post-nicotine administration. Cigarette smoking enhanced opioid withdrawal suppression during the peak methadone condition, methadone attenuated nicotine withdrawal, and methadone and nicotine shared many of the same main effects, suggesting that smoking and methadone effects may be inseparable dimensions. In summary, the results of these studies suggest that in addition to physical symptoms, mood related factors are important to opioid withdrawal perception and that the mood factors and drug interactions can impact on a patient’s perception of satisfaction with methadone treatment.