Concurrent Heroin Use and Correlates among Methadone Maintenance Treatment Clients: A 12-Month Follow-up Study in Guangdong Province, China
Abstract
:1. Introduction
2. Experimental Section
2.1. Ethics Statement
2.2. Study Site and Participants
2.3. Study Procedure
2.4. Measures
2.4.1. Demographic Characteristics at Baseline
2.4.2. Multiple Sex Partners at Baseline (over the Past Three Months)
2.4.3. Drug Use at Baseline
2.4.4. Methadone Information (Maintenance Dose and Attendance)
2.4.5. Concurrent Heroin Use during Study Period
2.4.6. Laboratory Tests
HIV and HCV Tests
Urine Morphine Test
2.5. Statistical Analysis
3. Results
3.1. Socio-Demographic Characteristics
3.2. HIV and HCV Infection Status at Baseline
3.3. Drug Use at Baseline
3.4. Average Maintenance Dose and Attendance
3.5. Heroin Use during the Study Period
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
- Zhao, M.; Ling, W. HIV/AIDS and drug use in China—Interactions, impacts, and issues. Subst. Use Misuse 2012, 47, 1015–1025. [Google Scholar] [CrossRef] [PubMed]
- The State Council Information Office of the People’s Republic of China. Annual Report on Drug Situation in China; The State Council Information Office of the People’s Republic of China: Beijing, China, 2014.
- Bao, Y.P.; Liu, Z.M. Systematic review of HIV and HCV infection among drug users in China. Int. J. Std. Aids 2009, 20, 399–405. [Google Scholar] [CrossRef] [PubMed]
- Pang, L.; Hao, Y.; Mi, G.; Wang, C.; Luo, W.; Rou, K.; Li, J.; Wu, Z. Effectiveness of first eight methadone maintenance treatment clinics in China. AIDS 2007, 21 (Suppl. S8), S103–S107. [Google Scholar] [CrossRef] [PubMed]
- Yin, W.; Hao, Y.; Sun, X.; Gong, X.; Li, F.; Li, J.; Rou, K.; Sullivan, S.G.; Wang, C.; Cao, X.; et al. Scaling up the national methadone maintenance treatment program in China: Achievements and challenges. Int. J. Epidemiol. 2010, 39, i29–i37. [Google Scholar] [CrossRef] [PubMed]
- Sun, H.M.; Li, X.Y.; Chow, E.P.F.; Li, T.; Xian, Y.; Lu, Y.H.; Tian, T.; Zhuang, X.; Zhang, L. Methadone maintenance treatment programme reduces criminal activity and improves social well-being of drug users in China: A systematic review and meta-analysis. BMJ Open 2015, 5, e5997. [Google Scholar] [CrossRef] [PubMed]
- Zhao, Y.; Shi, C.X.; McGoogan, J.M.; Rou, K.; Zhang, F.; Wu, Z. Methadone maintenance treatment and mortality in HIV-positive people who inject opioids in China. Bull. World Health Org. 2013, 91, 93–101. [Google Scholar] [CrossRef] [PubMed]
- Zou, X.; Ling, L.; Zhang, L. Trends and risk factors for HIV, HCV and syphilis seroconversion among drug users in a methadone maintenance treatment programme in China: A 7-year retrospective cohort study. BMJ Open 2015, 5, e8162. [Google Scholar] [CrossRef] [PubMed]
- Dai, J.; Zhao, L.; Liang, Y. Policy implementation of methadone maintenance treatment and HIV infection: Evidence from Hubei province, China. Subst. Abuse Treat. Prev. Policy 2013, 8, 2120–2124. [Google Scholar] [CrossRef] [PubMed]
- Tran, B.X.; Ohinmaa, A.; Duong, A.T.; Do, N.T.; Nguyen, L.T.; Nguyen, Q.C.; Mills, S.; Jacobs, P.; Houston, S. Changes in drug use are associated with health-related quality of life improvements among methadone maintenance patients with HIV/AIDS. Qual. Life Res. 2012, 21, 613–623. [Google Scholar] [CrossRef] [PubMed]
- Chou, Y.C.; Shih, S.F.; Tsai, W.D.; Li, C.S.; Xu, K.; Lee, T.S. Improvement of quality of life in methadone treatment patients in northern Taiwan: A follow-up study. BMC Psychiatry 2013, 13, 79–81. [Google Scholar] [CrossRef] [PubMed]
- Wu, Z. Landmark government methadone maintenance program in mainland China. In Proceedings of the 15th International AIDS Conference, Bangkok, Thailand, 11–16 July 2004.
- The National Health and Family Planning Commission of the People’s Republic of China. The National Health and Family Planning Commission Published Online. Available online: http://www.nhfpc.gov.cn/zhuzhan/zxfb/201506/f2bd445f5ec04085adb9b84d995cb22b.shtml (accessed on 6 January 2016).
- Sullivan, S.G.; Wu, Z.; Cao, X.; Liu, E.; Detels, R. Continued drug use during methadone treatment in China: A retrospective analysis of 19,026 service users. J. Subst. Abuse Treat. 2014, 47, 86–92. [Google Scholar] [CrossRef] [PubMed]
- Li, L.; Lin, C.; Wan, D.; Zhang, L.; Lai, W. Concurrent heroin use among methadone maintenance clients in China. Addict. Behav. 2012, 37, 264–268. [Google Scholar] [CrossRef] [PubMed]
- Wang, R.; Ding, Y.; Bai, H.; Duan, S.; Ye, R.; Yang, Y.; Wang, J.; Tang, R.; Gao, M.; He, N. Illicit heroin and methamphetamine use among methadone maintenance treatment patients in Dehong Prefecture of Yunnan Province, China. PLoS ONE 2015, 10, e133431. [Google Scholar] [CrossRef] [PubMed]
- Joseph, H.; Stancliff, S.; Langrod, J. Methadone maintenance treatment (MMT): A review of historical and clinical issues. Mt. Sinai J. Med. N.Y. 2000, 67, 347–364. [Google Scholar]
- Liu, E.; Wu, Z.; Liang, T.; Shen, L.; Zhong, H.; Wang, B. Etal Risk factors associated with continued heroin use during methadone maintenance treatment in Guizhou province, China. Zhonghua Yu Fang Yi Xue Za Zhi 2008, 42, 875–878. [Google Scholar] [PubMed]
- NetEase Guangdong Had Cumulatively Reported 48,718 HIV-infected Individuals, Ranking Fifth Position in China. Available online: http://news.163.com/14/1201/06/ACC0BV8E00014AEE.html (accessed on 6 January 2016).
- China’s Actual Drug Users over 13 Million Years of Consumption of Nearly 400 Tons of Drugs. Available online: http://www.china.com.cn/news/2014-11/03/content_33947964.htm (accessed on 6 January 2016).
- Guangdong Has the Largest Number of Registered Drug Users (457,000), Accounting for One-Sixth of the Total Registered Drug Users of China. Available online: http://news.china.com.cn/2014-11/19/content_34094460.htm (accessed on 6 January 2016).
- Liu, E.; Rou, K.; McGoogan, J.M.; Pang, L.; Cao, X.; Wang, C.; Luo, W.; Sullivan, S.G.; Montaner, J.S.G.; Bulterys, M.; et al. Factors associated with mortality of HIV-positive clients receiving methadone maintenance treatment in China. J. Infect. Dis. 2013, 208, 442–453. [Google Scholar] [CrossRef] [PubMed]
- Liu, H.; Li, J.; Lu, Z.; Liu, W.; Zhang, Z. Does Chinese culture influence psychosocial factors for heroin use among young adolescents in China? A cross-sectional study. BMC Public Health 2010, 10, 2359–2368. [Google Scholar] [CrossRef] [PubMed]
- Yap, L.; Wu, Z.; Liu, W.; Ming, Z.; Liang, S. A rapid assessment and its implications for a needle social marketing intervention among injecting drug users in China. Int. J. Drug Policy 2002, 13, 57–68. [Google Scholar] [CrossRef]
- Tran, B.X.; Ohinmaa, A.; Mills, S.; Duong, A.T.; Nguyen, L.T.; Jacobs, P.; Houston, S. Multilevel predictors of concurrent opioid use during methadone maintenance treatment among drug users with HIV/AIDS. PLoS ONE 2012, 7, e51569. [Google Scholar] [CrossRef] [PubMed]
- Wu, Z.; Zhang, J.; Detels, R.; Duan, S.; Cheng, H.; Li, Z.; Dong, L.; Huang, S.; Jia, M.; Bi, X. Risk factors for initiation of drug use among young males in southwest China. Addiction 1996, 91, 1675–1685. [Google Scholar] [CrossRef] [PubMed]
- Amato, L.; Davoli, M.; Perucci, C.A.; Ferri, M.; Faggiano, F.; Mattick, R.P. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: Available evidence to inform clinical practice and research. J. Subst. Abuse Treat. 2005, 28, 321–329. [Google Scholar] [CrossRef] [PubMed]
- Strain, E.C.; Bigelow, G.E.; Liebson, I.A.; Stitzer, M.L. Moderate- vs. high-dose methadone in the treatment of opioid dependence: A randomized trial. JAMA 1999, 281, 1000–1005. [Google Scholar] [CrossRef] [PubMed]
- Bao, Y.P.; Liu, Z.M.; Epstein, D.H.; Du, C.; Shi, J.; Lu, L. A meta-analysis of retention in methadone maintenance by dose and dosing strategy. Am. J. Drug Alcohol Abuse 2009, 35, 28–33. [Google Scholar] [CrossRef] [PubMed]
- Lin, C.; Wu, Z.; Detels, R. Family support, quality of life and concurrent substance use among methadone maintenance therapy clients in China. Public Health 2011, 125, 269–274. [Google Scholar] [CrossRef] [PubMed]
- Sullivan, S.G.; Wu, Z. Rapid scale up of harm reduction in China. Int. J. Drug Policy 2007, 18, 118–128. [Google Scholar] [CrossRef] [PubMed]
- Mattick, R.P.; Breen, C.; Kimber, J.; Davoli, M.; Breen, R. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst. Rev. 2009, 3, CD002209. [Google Scholar] [PubMed]
- China National Narcotics Control Commission (CNNCC). 2012 Annual Report on Drug Control in China; Ministry of Public Security: Beijing, China, 2012.
- Gu, J.; Xu, H.; Lau, J.T.F.; Hao, Y.; Zhong, Y.; Fan, L.; Zhao, Y.; Hao, C.; Ling, W. Misconceptions predict dropout and poor adherence prospectively among newly admitted first-time methadone maintenance treatment clients in Guangzhou, China. Addiction 2012, 107, 1641–1649. [Google Scholar] [CrossRef] [PubMed]
Variables | Heroin Use (n = 5110) | No Heroin Use (n = 1738) | Total (n = 6848) |
---|---|---|---|
No. (%) | No. (%) | No. (%) | |
Age (years) (χ2 = 0.07, p = 0.964) | |||
18– | 2384 (46.5) | 808 (46.5) | 3192 (46.6) |
35– | 2310 (45.2) | 785 (45.2) | 3095 (45.2) |
≥45 | 416 (8.3) | 145 (8.3) | 561 (8.2) |
Gender (χ2 = 3.02, p = 0.082 ) | |||
Male | 4721 (92.4) | 1583 (91.1) | 6304 (92.1) |
Female | 389 (7.6) | 155 (8.9) | 544 (7.9) |
Marital Status (χ2 = 2.76, p = 0.097) | |||
Married Currently | 2402 (47.0) | 777 (44.7) | 3179 (46.4) |
Other | 2708 (53.0) | 961 (55.3) | 3669 (53.6) |
Education Level (χ2 = 0.53, p = 0.768) | |||
Illiterate or primary school | 992 (19.4) | 327 (18.8) | 1319 (19.3) |
Junior high school | 3244 (63.5) | 1120 (64.4) | 4364 (63.7) |
Senior high school | 874 (17.1) | 291 (16.7) | 1165 (17.0) |
Employment Status (χ2 = 7.77, p = 0.005) | |||
Employed | 2126 (41.6) | 657 (37.8) | 2783 (40.6) |
Unemployed | 2984 (58.4) | 1081 (62.2) | 4065 (59.4) |
Family Relationship (χ2 = 64.45, p < 0.001) | |||
Harmonious | 3705 (72.5) | 1428 (82.2) | 5133 (75.0) |
Inharmonious | 1405 (27.5) | 310 (17.8) | 1715 (25.0) |
HIV-Infected at Baseline (χ2 = 5.92, p = 0.015) | |||
Yes | 435 (8.5) | 116 (6.7) | 551 (8.0) |
No | 4675 (91.5) | 1622 (93.3) | 6297 (92.0) |
HCV-Infected at Baseline (χ2 = 2.35, p = 0.126) | |||
Yes | 3901 (76.3) | 1358 (78.1) | 5259 (76.8) |
No | 1209 (23.7) | 380 (21.9) | 1589 (23.2) |
Multiple Sex Partners at Baseline (χ2 = 2.68 , p = 0.102) | |||
Yes | 358 (7.0) | 102 (5.9) | 460 (6.7) |
No | 4752 (93.0) | 1636 (94.1) | 6388 (93.3) |
Duration of Drug Use (years) (χ2 = 44.02, p < 0.001) | |||
<5 | 1485 (29.1) | 363 (20.9) | 1848 (27.0) |
5–10 | 829 (16.2) | 311 (17.9) | 1140 (16.6) |
≥10 | 2796 (54.7) | 1064 (61.2) | 3860 (56.4) |
Intravenous Drug Use at Baseline (χ2 = 47.36, p < 0.001) | |||
Yes | 3238 (63.4) | 1259 (72.4) | 4497 (65.7) |
No | 1872 (36.6) | 479 (27.6) | 2351 (34.3) |
Shared Intravenous Needles at Baseline (χ2 = 18.15, p < 0.001) | |||
Yes | 238 (4.7) | 49 (2.8) | 287 (4.2) |
No | 3000 (95.3) | 1210 (97.2) | 4210 (95.8) |
Average Maintenance Doses (mL) (χ2 = 3.37 , p = 0.066) | |||
<60 | 3553 (69.5) | 1249 (71.9) | 4802 (70.1) |
≥60 | 1557 (30.5) | 489 (28.1) | 2046 (29.9) |
Percentage of MMT Attendance (%) (χ2 = 44.02, p < 0.001) | |||
<20 | 1327 (26.0) | 442 (25.4) | 1769 (25.8) |
20– | 1411 (27.6) | 467 (26.9) | 1878 (27.4) |
50– | 1155 (22.6) | 295 (17.0) | 1450 (21.2) |
≥80% | 1217 (23.8) | 534 (30.7) | 1751 (25.6) |
Positive Percentage (%) | Number (n) | Percentage (%) |
---|---|---|
0 | 1738 | 25.38 |
>0 | 311 | 4.54 |
10– | 721 | 10.53 |
20– | 478 | 6.98 |
30– | 532 | 7.77 |
40– | 671 | 9.80 |
50– | 233 | 3.40 |
60– | 325 | 4.75 |
70– | 318 | 4.64 |
80– | 154 | 2.25 |
90– | 1367 | 19.96 |
Total | 6848 | 100.0 |
Variables | Univariate | Multivariate | ||
---|---|---|---|---|
OR (95% CI) a | p | OR (95% CI) | p | |
Age (years) | ||||
18– | 1.03 (0.84–1.26) | 0.789 | 0.93 (0.75–1.16) | 0.534 |
35– | 1.03 (0.83–1.31) | 0.809 | 0.98 (0.79–1.21) | 0.843 |
≥45 | 1.00 | 1.00 | ||
Gender | ||||
Male | 1.19 (0.98–1.44) | 0.082 | 1.14 (0.93–1.39) | 0.199 |
Female | 1.00 | 1.00 | ||
Marital Status | ||||
Married Currently | 1.10 (0.98–1.22) | 0.097 | 1.10 (0.98–1.24) | 0.093 |
Others | 1.00 | 1.00 | ||
Education Level | ||||
Illiterate or primary school | 1.01 (0.84–1.21) | 0.914 | 0.98 (0.82–1.19) | 0.867 |
Junior high school | 0.96 (0.83–0.12) | 0.633 | 0.95 (0.82–1.11) | 0.513 |
Senior high school | 1.00 | 1.00 | ||
Employment Status | ||||
Employed | 1.17 (1.05–1.31) | 0.005 | 0.92 (0.82–1.03) | 0.146 |
Unemployed | 1.00 | 1.00 | ||
Family Relationship | ||||
Harmonious | 1.00 | 1.00 | ||
Inharmonious | 1.75 (1.52–2.00) | <0.001 | 1.49 (1.24–1.78) | <0.001 |
HIV-Infected at Baseline | ||||
Yes | 1.30 (1.05–1.61) | 0.015 | 1.25 (1.01–1.55) | 0.047 |
No | 1.00 | 1.00 | ||
HCV-Infected at Baseline | ||||
Yes | 0.90 (0.79–1.03) | 0.126 | 1.08 (0.93–1.24) | 0.324 |
No | 1.00 | 1.00 | ||
Multiple Sex Partners at Baseline | ||||
Yes | 1.21 (0.96–1.52) | 0.102 | 1.34 (1.07–1.69) | 0.012 |
No | 1.00 | 1.00 | ||
Duration of Drug Use (years) | ||||
<5 | 1.56 (1.36–1.78) | <0.001 | 1.10 (0.91–1.33) | 0.347 |
5–10 | 1.01 (0.88–1.18) | 0.850 | 1.04 (0.89–1.21) | 0.658 |
≥10 | 1.00 | 1.00 | ||
Intravenous Drug Use at Baseline | ||||
Yes | 0.66 (0.58–0.74) | <0.001 | 0.81 (0.69–0.95) | 0.009 |
No | 1.00 | 1.00 | ||
Average Maintenance Doses (mL) | ||||
<60 | 1.00 | 1.00 | ||
≥60 | 1.12 (0.99–1.26) | 0.066 | 1.13 (1.01–1.28) | 0.047 |
Percentage of MMT Attendance (%) | ||||
<20 | 1.32 (1.14–1.53) | <0.001 | 1.32 (1.13–1.53) | <0.001 |
20– | 1.33 (1.15–1.53) | <0.001 | 1.33 (1.14–1.54) | <0.001 |
50– | 1.72 (1.46–2.02) | <0.001 | 1.69 (1.44–2.00) | <0.001 |
≥80% | 1.00 | 1.00 |
Variables | <20% n (%) * | 20%–80% n (%) * | >80% n (%) * | OR (95% CI) a,b | p b |
---|---|---|---|---|---|
Age (years) | |||||
18– | 378 (15.86) | 1319 (55.33) | 687 (28.82) | 1.00 | |
35– | 357 (15.45) | 1264 (54.72) | 689 (29.83) | 1.26 (1.11–1.43) | <0.001 |
≥45 | 67 (16.11) | 204 (49.04) | 145 (34.86) | 1.63 (1.30–2.05) | <0.001 |
Gender | |||||
Male | 737 (15.61) | 2587 (54.80) | 1397 (29.59) | 1.00 | |
Female | 65 (16.71) | 200 (51.41) | 124 (31.88) | 1.60 (1.28–2.00) | <0.001 |
Marital Status | |||||
Married Currently | 379 (15.78) | 1322 (55.04) | 701 (29.18) | 0.95 (0.85–1.07) | 0.441 |
Others | 423 (15.62) | 1465 (54.10) | 820 (30.28) | 1.00 | |
Education Level | |||||
Illiterate or primary school | 169 (17.04) | 521 (52.52) | 302 (30.44) | 0.86 (0.71–1.04) | 0.116 |
Junior high school | 490 (15.10) | 1764 (54.38) | 990 (30.52) | 0.97 (0.83–1.14) | 0.710 |
Senior high school | 143 (16.36) | 502 (57.44) | 229 (26.20) | 1.00 | |
Employed Status | |||||
Employed | 302 (14.21) | 1121 (52.73) | 703 (33.07) | 1.00 | |
Unemployed | 500 (16.76) | 1666 (55.83) | 818 (27.41) | 1.02 (0.91–1.15) | 0.717 |
Family Relationship | |||||
Harmonious | 222 (16.64) | 752 (56.37) | 360 (26.99) | 1.00 | |
Inharmonious | 133 (9.47) | 760 (54.09) | 512 (36.44) | 1.56 (1.31–1.87) | <0.001 |
HIV-Infected at Baseline | |||||
Yes | 35 (8.05) | 243 (55.86) | 157 (36.09) | 1.76 (1.42–2.19) | <0.001 |
No | 767 (16.41) | 2544 (54.42) | 1364 (29.18) | 1.00 | |
HCV-Infected at Baseline | |||||
Yes | 658(16.87) | 2176(55.78) | 1067(27.35) | 0.91(0.79–1.06) | 0.234 |
No | 144(11.91) | 611(50.54) | 454(37.55) | 1.00 | |
Multiple Sex Partners at Baseline | |||||
Yes | 736 (15.49) | 2612 (54.97) | 1404 (29.55) | 0.95 (0.76–1.19) | 0.655 |
No | 66 (18.44) | 175 (48.88) | 117 (32.68) | 1.00 | |
Duration of Drug Use (years) | |||||
<5 | 143 (9.63) | 808 (54.41) | 534 (35.96) | 1.21 (0.99–1.47) | 0.062 |
5–10 | 147 (17.73) | 436 (52.59) | 246 (29.67) | 1.17 (0.99–1.39) | 0.063 |
≥10 | 512 (18.31) | 1543 (55.19) | 741 (26.50) | 1.00 | |
Intravenous Drug Use at Baseline | |||||
Yes | 592 (18.28) | 1798 (55.53) | 848 (26.19) | 1.00 | |
No | 210 (11.22) | 989 (52.83) | 673 (35.95) | 1.29 (1.10–1.52) | 0.002 |
Average Maintenance Doses (mL) | |||||
<60 | 550 (15.48) | 1882 (52.97) | 1121 (31.55) | 1.00 | |
≥60 | 252 (16.18) | 905 (58.12) | 400 (25.69) | 1.19 (0.98–1.27) | 0.085 |
Percentage of MMT Attendance (%) | |||||
<20 | 20 (1.51) | 382 (28.79) | 925 (69.71) | 38.43 (31.60–46.74) | <0.001 |
20– | 117 (8.29) | 936 (66.34) | 358 (25.37) | 5.42 (4.57–6.44) | <0.001 |
50– | 233 (20.17) | 777 (67.27) | 145 (12.55) | 2.11 (1.77–2.49) | <0.001 |
≥80% | 432 (35.50) | 692 (58.86) | 93 (7.64) | 1.00 |
© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Luo, X.; Zhao, P.; Gong, X.; Zhang, L.; Tang, W.; Zou, X.; Chen, W.; Ling, L. Concurrent Heroin Use and Correlates among Methadone Maintenance Treatment Clients: A 12-Month Follow-up Study in Guangdong Province, China. Int. J. Environ. Res. Public Health 2016, 13, 305. https://doi.org/10.3390/ijerph13030305
Luo X, Zhao P, Gong X, Zhang L, Tang W, Zou X, Chen W, Ling L. Concurrent Heroin Use and Correlates among Methadone Maintenance Treatment Clients: A 12-Month Follow-up Study in Guangdong Province, China. International Journal of Environmental Research and Public Health. 2016; 13(3):305. https://doi.org/10.3390/ijerph13030305
Chicago/Turabian StyleLuo, Xiaofeng, Peizhen Zhao, Xiao Gong, Lei Zhang, Weiming Tang, Xia Zou, Wen Chen, and Li Ling. 2016. "Concurrent Heroin Use and Correlates among Methadone Maintenance Treatment Clients: A 12-Month Follow-up Study in Guangdong Province, China" International Journal of Environmental Research and Public Health 13, no. 3: 305. https://doi.org/10.3390/ijerph13030305