Multiple Substances Use Among Methadone Maintenance Clients And Its Relations With Treatment Adherence

ObjectiveThis study aimed to investigate the situation of multiple substances use in methadone maintenance treatment(MMT)clinics of Jiangsu province and its influence on treatment adherence by using types,frequency and duration.And evidences are provided for directional intervention,lower rate of multiple substances use and better treatment adherence among key population.MethodA cross-sectional survey was conducted in five MMT clinics of Jiangsu Province in May 2017.Investigated substances in this study included methamphetamine(MAMP),benzodiazepine(BZD),ketamine,buprenorphine and 3,4-methylenedioxymethamphetamine(MDMA).Information about demographic characters,situation of MMT and drug abuse,family and social support of MMT clients were collected by a well-developed questionnaire,urine test and China's National MMT Information Management System.Logistic regression was used for all calculations of the odds ratio(OR)and their 95%CIs,adjusting for potential confounders.ResultsA total of 496 patients were included in this study,most of them are male(75.8%),graduated from junior high school(49.1%),Han ethnicity(97.8%),married or co-habiting(51.6%)and unemployed(60.3%).23.2%of the participants used at least one of the investigated substances currently.The using rate of BZD,MAMP,MDMA,ketamine and buprenorphine in the last six months were 14.5%,8.7%,2.6%,2.0%and 2.0%respectively.The main reasons MMT clients using multiple substances are friends influence(30.4%),feeling empty and boring(22.6%),pursuit of euphoria(19.1%),higher working efficiency(19.1%)and better sexuality(17.4%).The majority of participants(53.8%)exhibited poor treatment adherence.Using multiple substances could increase the risk of poor MMT adherence(OR=1.74,95%CI:1.04-2.91).And the risk of poor adherence was 2.50(95%CI:1.12-5.57)times higher among MAMP abusers than those use none of the investigated substances,while MMT adherence of those clients abusing BZD remained nearly the same as non-users of the investigated substances(OR=1.31,95%CI:0.69-2.48).And using MDMA,ketamine or buprenorphine could also increase the rate of poor adherence(OR=2.96,95%CI:1.01-8.69).Moreover,the risk of poor adherence showed a rising tendency as the using types(P=0.007)and frequency(P=0.048)of MAMP,MDMA,ketamine and buprenorphine(MMKB)increased.And the clients with less using duration of MMKB tended to have a higher risk of poor MMT adherence,especially for those whose using duration less than 3 years(OR=3.30,95%CI:1.23-8.91).ConclusionsMultiple substances use,especially BZD and MAMP,are now prevalent among MMT clients in Jiangsu Province,China.Moreover,the using frequency and duration of multiple substances are also associated with treatment adherence.Further researches are needed to explore effective interventions to cope with the prevalence of multiple substances use and enhance MMT career in China.