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Dose Tapering Strategy for Heroin Abstinence among Methadone Maintenance Treatment Participants: Evidence from A Retrospective Study in Guangdong, China

by Qian Lu, Xia Zou, Yin Liu, Cheng Gong and Li Ling *
Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
*
Author to whom correspondence should be addressed.
These authors contributed equally to the work.
Int. J. Environ. Res. Public Health 2019, 16(15), 2800; https://doi.org/10.3390/ijerph16152800
Received: 10 June 2019 / Revised: 26 July 2019 / Accepted: 3 August 2019 / Published: 6 August 2019
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
Around half of methadone maintenance treatment (MMT) participants choose the tapering phase, however, the guidelines on tapering differ between countries and only include the tapering rate. Physicians need more evidence to guide clinical practice. We aimed to explore a specific tapering strategy to improve heroin abstinence among MMT participants. We conducted a retrospective study from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 853 participants with 961 treatment episodes. We performed two-level hierarchical logistic regression models to identify tapering phase characteristics associated with heroin abstinence. Among all treatment episodes, 419 (43.6%) were heroin abstinent. Participants who started tapering after 52 weeks, had a taper start dose of less than 60 mg and a taper ratio of less than 5%/week, while a dose reduction in 75%–89% of the tapering weeks provided the highest odds of heroin abstinence. This study highlights the need for a more gradual taper than current guidelines recommend and strongly suggests the inclusion of other tapering phase characteristics. Those who start the tapering phase later, have a lower dose of methadone, with a more gradual rate of taper, and a dose reduction in 75%–89% of the tapering phase increased the odds of heroin abstinence. View Full-Text
Keywords: methadone maintenance treatment; tapering phase; heroin abstinence. methadone maintenance treatment; tapering phase; heroin abstinence.
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Lu, Q.; Zou, X.; Liu, Y.; Gong, C.; Ling, L. Dose Tapering Strategy for Heroin Abstinence among Methadone Maintenance Treatment Participants: Evidence from A Retrospective Study in Guangdong, China. Int. J. Environ. Res. Public Health 2019, 16, 2800.

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