Curative Effect Evaluation Of Methadone Maintenance Treatment Program In Heroin Addicts From Guangxi,China

Objectives 1) To validate the reliability, validity and responsibility of the Chinese version of addiction severity index (ASI). 2) To assess addiction of patients in methadone maintenance treatment (MMT) and understand their treatment compliance and influencing factors. 3) To assess the efficacy of outpatient methadone maintenance treatment after 6 months with the Chinese version of scale.Methods 1) Participants were chosen from patients in five MMT clinics in Guangxi. 240 patients initially participating in the MMT program less than 1 month were interviewed face-to-face by trained interviewers. A week later 50 cases selected randomly were interviewed again. 2) Heroin addicts who were primarily treated in one of the 21 MMT clinics in Guangxi Province were recruited into the cohort with informed consent from March to July 2009.Baseline data from the clients were collected with an ad-hoc questionnaire including addiction severity index of Chinese version (ASI-C) by face to face interview. 3)They were followed-up six months after MMT to evaluate its effectiveness and responsibility of addiction severity index of Chinese version.ResultsA total of 1 123 MMT clients were enrolled from 21 MMT clinics into the study and 658 of them were followed-up for six months.1. Reliability and validity of addiction severity index of Chinese versionThe study indicated a good internal consistency of composite scores of ASI-C, with an average Cronbach's alpha greater than 0.60, as an acceptable level overall. The study in 50 clients, in general showed good enough test-retest reliability of the composite scores (CSs) of ASI-C with an interval of seven days.All the seven domains were extracted from the ASI-C by factor analysis in verification study, consistent with those in construct validity of the original version of ASI.2. Demographic characteristics of the clients in MMTAverage age of 1 123 participants was 32.6 years, 64.6 percent under 35 years, 9.9 percent women, 87.8 percent with junior high school education or below and 41.6 percent unmarried, and 52.3 percent of them got living support from their families or relatives.74.2 percent of the participants were IDUs.Each of the clients took 49 mg of methadone per day in average.3. Retention in MMT of the clients and its related factorsThe study lasted for 12 months and the clients maintain the median duration of 162 days. Retention rate in the 1 123 clients was 92.3 percent, 75.9 percent, 58.7 percent and 42.4 percent in the 1th month, 3th month, 6th month and 12th month of MMT, respectively, estimated by Kaplan-Meier method.Main factors influencing retention of the clients in MMT included their awareness of MMT and daily dose of methadone they took. Risk for withdrawal from MMT decreased by 20 percent with increase in daily dose of methadone 25mg, with a hazard ratio of 0. 217 (P<0.01). If the clients understood that they should take methadone life-time as they entered MMT program, their risk for withdrawal would be lower than those who did not understand, with a hazard ratio of 0.665(P<0.05).4. Effectiveness of MMTAddiction severity index of the clients significantly decreased after six-month MMT, and scores of five domains in ASI-C, i.e., employment, drug addiction, legal status, family and social status, and psychiatric status, all significantly declined, as compared to those at baseline (P<0.01).5. Clients continued heroin use during MMTAbout 30 percent of the clients were positive for urine morphine during the first 8 months of MMT, suggesting they continued to use heroin, and then positive rate of urine morphine decreased obviously to about 20 percent by the 9th month and to less than 7.25 percent by the end of the 12th month.ConclusionsThe clients participated in MMT in Guangxi were younger and less educated. About half of the participants could retain in MMT after 12-month treatment. Age, educational level, daily methadone dose, making friends with drug addicts and their awareness of MMT were main predictors of retention in MMT. MMT was significantly effective with six-month retention, but more concerns should be attached to those clients who continued to use heroin during the treatment. Reliability, validity and responsibility of ASI-C available is fundamentally acceptable, but further modification is needed based on culture in China.