| Background Since the establishment of the first clinic in 2004, Methadone Maintenance Treatment (MMT) has been extensively promoted in China. As of April 2009, MMT has been made available in 24 provinces (municipalities and autonomous regions) treating more than 20 million patients. The major challenge of MMT program in China is poor treatment adherence. Patients'understanding about prognosis, methadone properties, side effects and other aspects of MMT may lead to different attitudes toward the treatment. The impact of different attitudes toward MMT on treatment adherence remains a mystery.Objective To understand the cognitive and attitude of heroin addicts towards MMT; to investigate the risk factors of heroin addicts'attitude towards MMT; and to analysis the relationship between heroin addicts'attitude towards MMT and adherence.Methods A qualitative and quantitative study design. Through in-depth interviews we can have a deep understanding of heroin addicts'attitude towards MMT and the influential factors. By quantitative surveys we can recognize the indicators of heroin addicts'attitudes towards MMT including demographic characteristics, history of drug abuse and treatment, family support, heroin addicts'community factors and some other factors. We did statistical analysis to explore the impact of attitude and the relationship between attitudes towards MMT and treatment adherence.Results (1) 1965 participants (39.3%) fully approved "Withdrawal syndrome of methadone is less serious than that of heroin". The top 3 fully approved statements were "The support from family and society is essential to methadone maintenance treatment" with 3931 participants (78.6%) approved, "Full dosage of methadone can take away the carving for heroin" with 3175 participants (63.5%) approved and "Long-term methadone maintenance treatment is more effective than short-term methadone abstinence treatment" with 3054 participants (61.3%) approved. A total of 4210 participants (84.2%) had ever heard of or even believed "quitting methadone is harder than quitting heroin", whereas 3188 participants (73.8%) were convinced by the idea of "methadone is more toxic than heroin". Another 3178 participants (73.5%) with "Comparing to heroin, methadone is a'legal' drug ". Only 1886 participants (37.7%) said that continue to use heroin during the medication was totally unacceptable. While 2934 participants (58.7%) expressed reluctance to participate in MMT for a long time,3798 participants (72.6%) totally agreed with "Methadone help us lead a normal life", and another 3612 (69%) participants agreed "With methadone you can eventually get off form illegal drugs if you want to".3292 (62.9%) agreed "Methadone takes away the carving for heroin".3272 (62.5%) agreed "Methadone programs help with the criminal problem".3152 (60.2%) agreed "Methadone has proven to be the best way of quitting heroin". The regression model found that men (OR=1.31, CI (1.08-1.60)), younger age (OR=0.98, CI (0.96-0.99)), being HIV-negative (OR=1.38, CI (1.14-1.66)), with more negative information received (OR=0.14, CI (1.09-1.21)), higher rate of positive urine analysis (OR=1.55, CI (1.15-2.09)) were related to poor attitude towards MMT. Better family support (OR=0.89, CI (0.88-0.9)), never been arrested during treatment (OR=0.7, CI (0.54-0.9)), better perception of MMT benefits (OR=0.82, CI (0.75-0.88)), better knowledge for MMT (OR=0.71, CI (0.65-0.77)), better approval for maintenance treatment (OR= 0.82, CI (0.68-1)), better relationship with doctors (OR=0.91, CI (0.83-0.99)), higher frequency of clinic activities (OR=0.9, CI (0.84-0.97)), better health education (OR= 0.82, CI (0.79-0.84)), higher frequency of urine analysis (OR= 0.94, CI (0.92-0.97)) were related to better attitude towards MMT.Through cluster analysis and nonparametric analysis, the relationship between attitude towards MMT and compliance, more days attending medication, relatively higher methadone dose, better urine analysis participation, and lower rate of positive urine analysis were related to better attitude towards MMT.Conclusion Most heroin addicts understand the benefit of MMT but the rumors about the side effects of MMT are also commonly believed. Many addicts cannot accept the idea of life-long treatment which makes them quit. Personal characteristics of heroin addicts, family environment, drug-using environment have great impact on attitude towards MMT. The results demonstrate that better adherence is related to better attitude. New interventions should be implemented to better educate the heroin addicts. |
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