Risk Factors Associated With Polydrug Use Among Clients Of Methadone Maintenance Treatment Clinics In China

ObjectivesTo determine polydrug abuse status,character,extent of injury and related behaviors among heroin addicts attending methadone maintenance treatment(MMT)program and to identity its associated risk factors.MethodsA cross-sectional study was conducted among 1 202 clients in 6 MMT clinics in Chongqing,Guangdong,and Jiangsu provinces.Demographic information,polydrug abuse status and risky sexual behaviors were collected.Urine specimen was collected to assess morphia,methyl amphetamine,ecstasy,buprenorphine and benzodiazepine testing.Polydrug abuse behaviors were described,and their associated risk factors were assessed using univariate analysis and multivariate analysis.Further in-depth interviews were conducted among 25 urine-positive drug users and 5 methadone clinic doctors.Record data was encoded according to key words or terms.Results1.Results of the cross-sectional survey:The average age of participants was 39.7 ±6.8 years old,and 910(75.7%)participants were male,98.8%of the participants were Han.751(62.5%)people were junior high school education or lower.682(56.7%)participants had no job.Divorced/widowed accounted for 18.3%.Average years of heroin was 15.6 士 4.8 years.963(80.1%)people had used heroin in injecting.Among them,291(30.2%)people reported having shared needles or syringes,976(81.2%)people had received compulsory treatment,28(2.3%)people were HIV-positive,and 985(81.9%)people were HCV-positive.The urine test results:the rate of urine morphine-positive was 31.5%,the rate of benzodiazepine-positive was 12.5%,the rate of methamphetamine-positive was 9.0%,the rate of buprenorphine-positive was 1.7%,the rate of ecstasy-positive was 1.1%.The results suggest that drug abuse of the clients in MMT,heroin-use accounted for a major proportion,at the same time,benzodiazepine-use and methamphetamine-use are also very common.The questionnaire results show:360(30.0%)people reported having polydrug-use while they were still in MMT.The drugs were heroin,valium,triazolam,tramadol,promethazine,methamphetamine,ecstasy,magu,morphine,buprenorphine,pethidine,cocaine,chlorpromazine,marijuana,diphenoxylate,dihydro-etorphine,analgesic powder,cough syrup and so on.The results of analysis indicated that area,occupation,relationship with family,the average dose of methadon,abuse of other drugs were statistically significant for the use of heroin.The results of multivariate analysis indicated that having occupation(OR=1.987,95%CI:1.359-2.904),bad relationship with his family(OR=2.058,95%CI:1.054-4.015),other drugs use(OR=2.395,95%CI:1.637-3.506)were risk factors.Area,occupation,marital status,casual partners,in the MMT time,having other drugs use before being in MMT,heroin-use were statistically significant for other drugs use.Jiangsu(OR=1.765,95%CI:1.260-2.473),having casual partners(OR=1.595,95%CI:1.008-2.523),having other drugs use before being in MMT(OR=5.304,95%CI:3.693-7.618),heroin-use(OR=2.611,95%CI:1.762-3.869)were risk factors.2.Results of qualitative study:We interviewed 30 people,including 5 methadone clinic doctors and 25 drug users.The average age of drug users was 37.7 ± 1.6 years old.Among the 25 drug users,23 ones were male,and 2 ones were female;9 ones were unmarried,11 ones were married,and 5 ones were divorced;Relationship with family:7 ones were poor,8 ones were ordinary,and 10 ones were good.All of them had polydrug use experiences.The reasons for polydrug use were complex and diverse,but misconceptions about MMT were the main reason.Some drug users thought that methadone would be harmful to the body,methadone had greater addiction,and that methadone was inconvenient to work and life.So some drug users intended to quit the methadone or to gradually reduce their doses.Thus they use other drugs to replace methadone or to ease the withdrawal symptoms.ConclusionContinued heroin use and other drugs use was common in MMT clinics.The reasons for polydrug use were complex and diverse,misconceptions about MMT were the main reason,therefore,more effective detection methods should be adopted to detect other drugs in addition to heroin,and effective prevention and treatment measures should be adopted to deal with polydrug use in MMT clinics.