Challenges in Methadone Maintenance Therapy Retention among Residents in Remote Regions of Northern Thailand
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Abstract
Objective: To explore challenges in the retention in methadone maintenance therapy from the perspective of patients receiving treatment living in a remote area of Wiang-Haeng District, Chiang Mai Province. Method: In-depth interviews were conducted with 11 purposively selected patients and 3 community leaders in Wiang-Haeng District, Chiang Mai Province between August 1, 2022 to April 30, 2023. Semi-structured interview guide was developed by using the theoretical concepts of risk environment framework, health belief model and shared decision-making model. Data were analyzed by content analysis. Results: The major barrier to retention in methadone maintenance therapy was the remote context of the Wiang-Haeng district. The mountainous forest terrain near the Thai-Myanmar border, which is a route for drug smuggling, makes it easy for people to access drugs. Travel difficulties make it difficult to receive methadone at a scheduled time. Limited amount of dispensed methadone requires frequent visits to the hospital. Traveling to a hospital is a burden to most people, especially those with low incomes whom transportation cost could affects their well-being. Lack of access to education has led people in the past to unaware that drugs are illegal. The majority of the population comprises ethnic minorities who have their own languages and cultures, making it difficult to communicate about therapy. Patients with family and community members of the same ethnic minority who support their therapy have better treatment compliance. Conclusion: The remote context of Wiang-Haeng District has an impact on patients’ retention of methadone maintenance treatment. Many factors involved in hindering and facilitating the methadone treatment makes treatment in remote areas complicated and different from that in other areas. Therefore, service deliveries must be in line with the local environment and be integrated with other relevant sectors.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
Azadfard M, Huecker M, Leaming J. Opioid addiction [online]. 2021 [cited 26 July 2021]. Available from: www.statpearls.com/articlelibrary/viewarticle/26212/?utm_source=pubmed&utm_campaign=CME&utm_content=26212
Verachai V, Pattrakorn A, Lukkhanapichonshut L, Chuchareon P, Tongpanich C, Wittayanukooonluck A, et al. Drugs and addictive substances. Nonthaburi: Department of Medical Services, Ministry of Public Health; 2014.
Hayashi K, Ti L, Fairbairn N, Kaplan K, Suwannawong P, Wood E, et al. Drug-related harm among people who inject drugs in Thailand: summary findings from the Mitsampan Community Research Project. Harm Reduction J 2013; 10: 2-9.
Gowing, L R, Hickman M, Degenhardt L. Mitigating the risk of HIV infection with opioid substitution treatment. Bull World Health Organ 2013, 91: 148-9.
Duangrithi D, Cheewinaphirak N, Jansiriyanan R, Phetnil T. Improvement of methadone maintenance treatment guideline for opioid dependency. Srinagarind Medical Journal. 2021; 36: 119-25.
Mahathep P, Thananarapong J. Factors that affect treatment outcome of opioid use disorder with community participation in Maeteang, Chiangmai province. Thammasat University Hospital Journal Online. 2018; 3: 28-38.
Pattrakorn A, Sumrantiwawan W, Boonchaipanichwat thana S, Lapini T, Ngarmkachornwiwat A, Ukaranun W, et al. Standards for long-term methadone therapy in Thailand. Bangkok: Chulalongkorn University Printing House; 2013.
Suwanmajo S, Duangrithi D, Komkla N, Phattanachot W, Sathaporn U. Predictors – one year retention methadone maintenance therapy at princess mother institute on drug abuse treatment. Journal of the Department of Medical Services. 2019; 44: 119-24.
Zhou K, Li H, Wei X, Li X, Zhuang G. Medication adherence in patients undergoing methadone maintenance treatment in Xi’an, China. J Addict Med 2017; 11: 28-33.
Navidian A, Kermansaravi F, Tabas EE, Saeedinezhad F. Efficacy of group motivational interviewing in the degree of drug craving in the addicts under the methadone maintenance treat- ment (MMT) in South East of Iran. Arch Psychiatr Nurs 2016; 30: 144-9.
Darker CD, Ho J, Kelly G, Whiston L, Barry J. Demographic and clinical factors predicting retention in methadone maintenance: results from an Irish cohort. Ir J Med Sci. 2016; 185: 433-41.
Mertens JR, Weisner CM. Predictors of substance abuse treatment retention among women and men in an HMO. Alcohol Clin Exp Res. 2000; 24: 1525–33.
Mancino M, Curran G, Han X, Allee E, Humphreys K, Booth BM. Predictors of attrition from a national sample of methadone maintenance patients. Am J Drug Alcohol Abuse 2010; 36: 155–60.
Khampang R, Assanangkornchai S, Teerawatta nanon Y. Perceived barriers to utilise methadone maintenance therapy among male injection drug users in rural areas of Southern Thailand. Drug Alcohol Rev 2015; 34: 645-53.
Hayashi K, Ti L, Ayutthaya P, Suwannawong P, Kaplan K, Small W et al. Barriers to retention in methadone maintenance therapy among people who inject drugs in Bangkok, Thailand: a mixed-methods study. Harm Reduct J 2017; 14: 63. doi: 10.1186/s1 2954-017-0189-3.
Hawangchu D, Chamratrithirong A, Phuengsamran D. Stigmatization phenomena among people who use groups: a case study from community-based MMT Clinics. Journal of Public Health 2017; 47: 276-88.
Highland Research and Development Institute. Royal project-style highland development project area to solve specific area problems: Highland research and development institute [online]. 2021 [cited Jul 31, 2021]. Available from: www.hrdi.or.th/ AreaOfOperations/SolveOpium
Sarasvita R, Tonkin A, Utomo B, Ali R. Predictive factors for treatment retention in methadone programs in Indonesia. J Subst Abuse Treat 2012; 42: 239–46.
Peles E, Linzy S, Kreek M, Adelson M. One-year and cumulative retention as predictors of success in methadone maintenance treatment: a comparison of two clinics in the United States and Israel. J Addict Dis 2008; 27: 11-25.
Nimsakul K, Suwannaprom P, Suttajit S. Complexity of implementing harm reduction services in community hospitals: A two-phase qualitative study. Thai J Pharm Sci 2022; 46: 324-34.
Rhodes T. The ‘risk environment’: a framework for understanding and reducing drug-related harm. Int J Drug Policy 2002; 13: 85–94.
Becker M. The health belief model and sick role behavior. Health Ed Monograph 1974; 2: 410-9.
Marshall T, Hancock M, Kinnard E, Olson K, Abba-Aji A, Rittenbach K et al. Treatment options and shared decision-making in the treatment of opioid use disorder: A scoping review. J Subst Abuse Treat 2022; 135: 108646.
Stiggelbout AM, Pieterse AH, De Haes JC. Shared decision making: Concepts, evidence, and practice. Patient Educ Couns 2015; 98: 1172-9.
Timoer, S., Murti, B. and Soemanto, R., 2016. Factor analysis with health belief model on the adherence to methadone maintenance therapy. J Epidemiol Public Health 2016: 1: 49-57.
Rosenstock I M. The health belief model and prevention health behavior. Health Educ Monog 1974; 2: 355-85.
Ethnicity Education Public Health Cultural Traditions. This winter in Wianghaeng: Secrets of Chiang Mai [online]. 2021 [cited Aug 23, 2021]. Available from: whianghaeng.wordpress.com/perso nal
Joosten E, de Jong C, de Weert-van Oene G, Sensky T, van der Staak C. Shared decision-making reduces drug use and psychiatric severity in substance-dependent patients. Psychother Psycho som 2009; 78: 245-53.