在越南使用甲基苯丙胺进行美沙酮维持治疗的人群中，不坚持治疗和同时使用阿片类药物。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment Pub Date : 2025-03-27 DOI:10.1016/j.josat.2025.209686

Nguyen Bich Diep , Nguyen Thu Trang , Do Duc Huy , Hoang Thi Hai Van , Thai Thanh Truc , Do Van Dung , Michael J. Li , Steve J. Shoptaw , Li Li , Le Minh Giang

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引用次数: 0

摘要

导言：阿片类药物和甲基苯丙胺同时使用的全球上升对稳定的美沙酮维持治疗（MMT）提出了挑战。我们评估了在越南使用甲基苯丙胺的MMT患者中不遵守治疗和同时使用阿片类药物以及相关因素。方法：本分析利用了一项随机临床试验的基线数据，该试验旨在调查越南MMT患者使用甲基苯丙胺的各种循证行为干预组合的有效性（STAR-OM R01DA050486）。我们使用了来自498名MMT参与者的数据，这些参与者在过去30 天内自我报告使用甲基苯丙胺，并且已经接受MMT治疗至少三个月。该研究通过医疗记录审查确定了MMT的依从性，并通过尿液测试评估了阿片类药物的同时使用，并在医疗记录中记录了测试结果。结果：近3个月内，145例（29.1 %）未坚持使用MMT， 212例（42.6 %）同时使用阿片类药物。没有遵守MMT在相当与生活密切相关的距离诊所(aOR = 1.80,95 % CI: 1.10 - -2.90),被HIV阳性(aOR = 0.51,95 % CI: 0.27 - -0.97),并略微相关使用冰毒减少情感压抑(aOR = 1.56,95 % CI: 0.99 - -2.45)。并发阿片类药物使用与接受治疗诊所建立扩大时期(aOR = 1.80,95 % CI: 1.13 - -2.87),较长时间的治疗在目前诊所(aOR = 0.98,95 % CI: 0.97 - -0.99),男性性别(aOR = 2.09,95 % CI: 1.05 - -4.13),和曾经注射冰毒(aOR = 1.98,95 % CI: 1.13 - -3.46),除了MMT缺乏依从性(aOR = 2.71,95 % CI: 1.72 - -4.29)。结论：在越南使用美沙酮的甲基苯丙胺患者中，不遵守MMT和同时使用阿片类药物的情况很普遍。除了影响美沙酮计划的因素外，甲基苯丙胺的增加使这些挑战更加复杂。未来的干预策略必须同时解决潜在问题和甲基苯丙胺使用行为，以有效改善治疗结果。试验注册：NCT04706624。注册于2021年1月13日。https://clinicaltrials.gov/ct2/show/NCT04706624。

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Non-adherence to treatment and concurrent opioid use among people on methadone maintenance treatment using methamphetamine in Vietnam

Introduction

The global rise of concurrent use of opioids and methamphetamine presents challenges to stable methadone maintenance treatment (MMT). We assessed non-adherence to treatment and concurrent opioid use, along with associated factors, among people on MMT using methamphetamine in Vietnam.

Methods

This analysis utilized baseline data from a randomized clinical trial designed to investigate the effectiveness of various combinations of behavioral evidence-based interventions for methamphetamine use among patients on MMT in Vietnam (STAR-OM R01DA050486). We used data from 498 participants on MMT who self-reported using methamphetamine in the past 30 days and had been in MMT treatment for at least three months. The study determined adherence to MMT through medical record review and assessed concurrent opioid use via urine testing and documented test results in medical records.

Results

Within the last three months, 145 (29.1 %) did not adhere to MMT, and 212 (42.6 %) concurrently used opioids. Non-adherence to MMT were strongly associated with living at a considerable distance from the clinic (aOR = 1.80, 95 % CI: 1.10–2.90), being HIV positive (aOR = 0.51, 95 % CI: 0.27–0.97), and were marginally associated with using methamphetamine to reduce emotional distress (aOR = 1.56, 95 % CI: 0.99–2.45). Concurrent opioid use was associated with receiving treatment at clinics established during the scale-up period (aOR = 1.80, 95 % CI: 1.13–2.87), an extended duration of treatment at current clinics (aOR = 0.98, 95 % CI: 0.97–0.99), male gender (aOR = 2.09, 95 % CI: 1.05–4.13), and ever injecting methamphetamine (aOR = 1.98, 95 % CI: 1.13–3.46), besides MMT non-adherence (aOR = 2.71, 95 % CI: 1.72–4.29).

Conclusion

Non-adherence to MMT and concurrent opioid use are prevalent among methamphetamine-using patients on methadone in Vietnam. Alongside well-documented factors influencing methadone program, the rise in methamphetamine adds further complexity to these challenges. Future intervention strategies must address both the underlying issues and methamphetamine use behaviors to effectively improve treatment outcomes.

Trial registration

NCT04706624. Registered 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624

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来源期刊

Journal of substance use and addiction treatment Biological Psychiatry, Neuroscience (General), Psychiatry and Mental Health, Psychology (General)

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