Effectiveness of Synthetic Opiate(Methadone)Treatment Program in Heroin Users in Jiangsu Province, China

Introduction: Heroin users can be easily infected with HIV if they share syringes with other HIV-positive heroin users because the syringes are generally contaminated by blood that is sucked in during injection. Heroin addiction is a type of repeated brain disease. Clinically, long-term heroin use results in uncontrollable, rash, and compulsive behavior directed toward obtaining and taking heroin. One of the most effective treatments is the use of methadone as a replacement and supplement for the endogenous opiate. HIV transmission among heroin users has become a severe problem in China. Jiangsu Province is located in southeast China and has a relatively well-developed economy. Four methadone maintenance treatment (MMT)clinics were set up in February 2006 to treat heroin users in this area. This study was conducted to evaluate the effectiveness of MMT. Objectives: To evaluate the effectiveness of a 1-year MMT in heroin users in Jiangsu Province with the aim of overcoming heroin use and prevention of blood-transmitted diseases, such as HIV, by sharing syringes. Methods: This study was conducted in 4 MMT clinics in Jiangsu Province, China. Repeated cross-sectional surveys of the target population were conducted before and after they received at least 1 year of treatment in the MMT clinics. A questionnaire survey was implemented for all patients from March to April 2006 in the first survey(n = 554). The second survey was performed from August to September 2007 and was administered among those who received MMT for more than 1 year(n = 804). One hundred ninety-six patients who were investigated in both surveys were also evaluated for factors contributing to behavioral change. Data were analyzed statistically by l and Fisher’s exact tests to examine the differences in social and behavioral characteristics between the first and second surveys. Multivariable logistic regression analysis was used to identify factors that affected changes in behavior related to heroin use, sexual intercourse, and social interactions. Results: MMT helped to reduce the proportion of heroin use from 89.4% in the first survey to 14.1% in the second survey(P < 0.001)and decrease the sharing of syringes from 15.0% in the first survey to 3.6% in the second survey(P < 0.001). It also improved the social and family function from 48.0% in the first survey to 82.3% in the second survey(P < 0.001). Both male and female patients tended to have fewer sex partners after MMT treatment than before treatment(P < 0.01). However, the percentage of patients using condoms in the last sexual intercourse in the first survey was 25.5%, while that in the second survey was 25.9%, which was not significantly different over the course of 1 year (P = 0.91). With regard to antisocial behavior, the percentage of patients caught in illegal acts by the police in the last 3 months decreased from 19.1% in the first survey to 3.1% in the second survey(P < 0.001). Antisocial behavior, including theft, prostitution, and dealing in heroin, decreased after 1 year of treatment in the MMT clinics(P < 0.05). In the follow-up study of 196 patients who participated in both surveys, we could not identify any specific demographic variable that could be attributed to promoting the prevention of heroin use. Thus, 392 平成20年度専門課程特別研究論文要旨 J. Natl. Inst. Public Health, 58(4): 2009 MMT treatment appeared to be effective regardless of demographic variables, such as age, gender, and socioeconomic status. When the blood of patients was tested after 1 year of treatment, none of the subjects had seroconverted to HIV-positive. Discussion and conclusion: MMT is effective in reducing heroin use and the sharing of syringes among heroin injectors, which decreases the risk of HIV transmission. Social and family relationships in patients were improved while antisocial behavior was decreased after 1 year of treatment at MMT clinics. The effects of MMT were independent of gender, age, marital status, or working status. It is suggested that the MMT platform in MMT clinics should be used to improve safe sex education. 393 平成20年度専門課程特別研究論文要旨 J. Natl. Inst. Public Health, 58(4): 2009 指導教官: 稲葉洋平,牛山明(生活環境部) 〈教育報告〉 平成20年度専門課程II 国際保健分野 Course Name: Master of Public Health in International Health Study on Japanese Infant Exposure to Furan