Challenges, Adaptations, and Preparedness for Challenges in Methadone Maintenance Therapy by Hospitals in Health Regions 1 and 2
Article Sidebar
Main Article Content
Abstract
Objective: To explore the challenges, adaptations, and preparedness for future challenges of public hospitals in Health Regions 1 and 2 that provide methadone maintenance therapy (MMT). Methods: This descriptive study was conducted using an online questionnaire with four sections: 1) challenges in coping with unexpected situations in MMT services; 2) adaptation to provide MMT services appropriate for the area; 3) factors supporting the acceptance and expansion of MMT services; and 4) preparedness for future challenges. The study collected the data between September 2022 and February 2023. Results: Thirty-seven hospitals in Health Regions 1 and 2 with MMT services completed the questionnaire. They faced both shock or acute and severe challenges, such as the COVID-19 pandemic, and stress or continuous pressing challenges due to the nature of addiction, the context of opioid patients (e.g., patient behavior), social context, and limitations in the readiness of the MMT service system. The hospitals adapted, especially in terms of manpower, guidelines or regulations, location, and equipment. They also prepared for future challenges by developing workforce plans, having backup equipment ready. Factors related to the design of services to fit the area's context and staff readiness were the main factors supporting the acceptance and sustainable expansion of MMT services in the community. Conclusions: MMT services face operational challenges, particularly during crises. Hospitals have responded to service challenges and have adapted differently to maintain their services. This implies the need for multiple internal and external support mechanisms for the health system to foster its resilience in crises and sustainable growth.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
Patarakorn A, Nakayothinsakul Y, Kunatham S, Chawanich S, Makulchorn J, Kitchom P. Harm reduction. Samut Sakhon: Health Administration Division; 2017.
Kulayasiri R, Rungniraldorn T. Recommendations for the clinical management and treatment of substance-related disorders. Bangkok: Thai Health Promotion Foundation; 2015.
Lertpiriyasuwat C, Charernsuk S, Thanprasertkul S, Oonnorm J. Methadone maintenance therapy and detoxification. Nonthaburi: Department of Disease Control; 2009.
Department of Health Service Support. Service plan for addiction and substance abuse in Thailand. Nonthaburi: Health Administration Division; 2018.
Drug Treatment Network, Narcotics control manage- ment center [online]. 2021 [cited Aug 10, 2021]. Available from: antidrugnew.moph.go.th/Runtime/ Runtime/Form/FrmPublicReport/.
Princess Mother National Institute on Drug Abuse Treatment. Guidelines for methadone maintenance therapy in Thailand. Pathumthani: CU Print; 2015.
Tan MZY, Prager G, McClelland A, McClelland A. Healthcare resilience: a meta-narrative systematic review and synthesis of reviews. BMJ Open 2023; 13: e072136. doi: 10.1136/bmjopen-2023-072136.
Hayashi K, Ti L, Ayutthaya PPN, 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.org/10.1186/s12954-017-0189-3
Khazaee-Pool M, Moeeni M, Ponnet K, Fallahi A, Jahangiri L, Pashaei T. Perceived barriers to methadone maintenance treatment among Iranian opioid users. Int J Equity Health 2018: 17; 75. doi: 10.1186/s12939-018-0787-z.
Lin C, Lan C-W, Li L, Rou K. Service providers' adherence to methadone maintenance treatment protocol in China. Int J Drug Policy 2018; 56: 1-5. doi: 10.1016/j.drugpo.2018.02.018.
Lin C, Wu Z, Rou K, Pang L, Cao X, Shoptaw S, et al. Challenges in providing services in methadone maintenance therapy clinics in China: service providers' perceptions. Int J Drug Policy 2010; 21: 173-8. doi: 10.1016/j.drugpo.2009.09.002.
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. doi: 10.56808/3027-7922.2577.
Wu F, Peng C-Y, Jiang H, Zhang R, Zhao M, Li J, et al. Methadone maintenance treatment in China: perceived challenges from the perspectives of service providers and patients. J Public Health 2013; 35: 206-12. doi: 10.1093/pubmed/fds079.
Yin W, Hao Y, Sun X, Gong X, Li F, Li J, et al. Scaling up the national methadone maintenance treatment program in China: achievements and challenges. Int J Epidemiol 2010; 39: ii29-37. doi: 10.1093/ije/dyq210.
National Health Commission Office. Constitution on the National Health System No. 3 [online]. 2022 [cited Feb 29, 2024]. Available from: www.nationalhealth.or.th/sites/default/files/upload_files/ChaterT3_final.pdf
Ministry of Public Health. Public health medical library 2018, 100-year edition. Nonthaburi: Office of the Permanent Secretary Ministry of Public Health; 2018.
European Observatory on Health Systems and Policies, Thomas S, Sagan A, Larkin J, Cylus J, Figueras J, et al. Strengthening health systems resilience: key concepts and strategies. European Observatory Policy Briefs. Copenhagen, Denmark: European Observatory on Health Systems and Policies, World Health Organization; 2020.
Turenne CP, Gautier L, Degroote S, Guillard E, Chabrol F, Ridde V. Conceptual analysis of health systems resilience: a scoping review. Soc Sci Med 2019; 232: 168-80. Doi: 10.1016/j.socscimed.2019.04.020.
World Health Organization. An integrated approach to building health systems resilience [online]. 2023 [cited Jun 12, 2023]. Available from: openwho.org /courses/health-service-resilience.
Zimmermann J, McKee C, Karanikolos M, Cylus J. Strengthening health systems: a practical hand- book for resilience testing. Paris: OECD Publishing; 2024.
World Health Organization. Building health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond: WHO position paper. Geneva: World Health Organization; 2021.
Healthcare Accreditation Institute. HA national forum: impact forum convention center Muang Thong Thani. Nonthaburi: Healthcare Accreditation Institute; 2022.
International Health Policy Program, Thailand. Guide for comprehensive understanding of health systems and policy. Nonthaburi: International Health Policy Program; 2022.
Leerapan B, Suphanchaimat R, Thammawijaya P, Sornsrivichai V, Teekasap P, Jaichuen W, et al. Synthesize the susceptible-exposed-infectious-recovered (SEIR) model for epidemiological forecasting of the COVID-19 pandemic in Thailand. Nonthaburi: Health Systems Research Institute; 2022.
Leerapan B, Suphanchaimat R, Thammawijaya P, Sornsrivichai V, Teekasap P, Jaichuen W, et al. Systems dynamics modeling of the epidemic situations with vaccinating the anti-COVID-19 in Thailand. Nonthaburi: Health Systems Research Institute; 2023.
Thomas S, Sagan A, Larkin J, Cylus J, Figueras J, Karanikolos M. Strengthening health systems resilience: key concepts and strategies. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2020.
Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A'Court C, et al. Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J Med Internet Res 2017; 19: e367. doi: 10.2196/jmir.8775.
Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A’Court C, et al. Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework. BMC Medicine 2018; 16: 66. doi: 10.1186/s12916-018-1050-6.
Horton TJ, Illingworth JH, Warburton WHP. Overcoming challenges in codifying and replicating complex health care interventions. Health Aff (Millwood) 2018; 37: 191-7. doi: 10.1377/hlthaff.2017.1161.
Kermode M, Choudhurimayum RS, Rajkumar LS, Haregu T, Armstrong G. Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India. Harm Reduct J 2020; 17: 68. doi: 10.1186/s12954-020-00413-z.
Sapkota B, Tulachan P, Jojha S, Chapagai M. Factors influencing client retention in methadone maintenance treatment clinics in the Kathmandu Valley. J Psychiatr Assoc Nepal 2019; 8: 9-14. doi 10.3126/jpan.v8i2.28018.
Yang F, Lin P, Li Y, Qun He QL, Fu X, Luo Y. Predictors of retention in community-based metha- done maintenance treatment program in Pearl River Delta, China. Harm Reduct J 2013; 10: 3. doi: 10.1186/1477-7517-10-3.
Chaiwuti P, Intawong K, Boonchieng W. Self-efficacy of opioids dependent patients on retention in methadone maintenance treatment. Academic Psychiatry and Psychology Journal 2021; 37: 31-46.
Sooktong K, Suttajit S, Suwannaprom P. Situation of methadone maintenance therapy in hospitals in health regions 1 and 2. [submitted for publication]
Lincharearn A. Qualitative data analysis techniques. Journal of Educational Measurement Mahasara- kham University 2012; 17: 17-29.
Witter S, Thomas S, Topp SM, Barasa E, Chopra M, Cobos D, et al. Health system resilience: a critical review and reconceptualisation. Lancet Glob Health 2023; 11: e1454-58. doi: 10.1016/S2214-109X(23)00279-6
Figgatt MC, Salazar Z, Day E, Vincent L, Dasgupta N. Take-home dosing experiences among persons receiving methadone maintenance treatment during COVID-19. J Subst Abuse Treat 2021; 123: 108276. doi: 10.1016/j.jsat.2021.108276.
Johnson Q, Mund B, Joudrey PJ. Improving rural access to opioid treatment programs. J Law Med Ethics 2018; 46: 437-9. doi: 10.1177/1073110518782951.
Leece P, Cavacuiti C, Macdonald EM, Gomes T, Kahan M, Srivastava A, et al. Predictors of opioid-related death during methadone therapy. J Subst Abuse Treat 2015; 57: 30-5. doi: 10.1016/j.jsat.2015.04.008.
Modesto-Lowe V, Brooks D, Petry N. Methadone deaths: risk factors in pain and addicted populations. J Gen Intern Med 2009; 25: 305-9. doi: 10.1007/s11606-009-1225-0.
Brands B, Blake J, Marsh DC, Sproule B. The Impact of benzodiazepine use on methadone maintenance treatment outcomes. J Addic Dis 2015; 27: 37-48. doi: 10.1080/10550880802122620
Smye V, Browne AJ, Varcoe C, Josewski V. Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: an intersectional lens in the Canadian context. Harm Reduct J 2011; 8: 17. doi: 10.1186/1477-7517-8-17
Glette MK, Ludlow K, Wiig S, Bates DW, Austin EE. Resilience perspective on healthcare professionals’ adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis. BMJ Open 2023; 13: e071828. doi: 10.1136/bmjopen-2023-071828.
Suen L, Nguyen O, Knight K. Learning from COVID-19: How pandemic-era policies for methadone prescribing could improve opioid treatment. California: California Health Care Foundation; 2022
Hunter SB, Dopp AR, Ober AJ, Uscher-Pines L. Clinician perspectives on methadone service delivery and the use of telemedicine during the COVID-19 pandemic: a qualitative study. J Subst Abuse Treat 2021; 124: 108288. doi: 10.1016/j.jsat. 2021
Krawczyk N, Rivera BD, Levin E, Dooling BCE. Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy. Lancet Public Health 2023; 8: e238-46. doi: 10.1016/S24 68-2667(23)00023-3.
Suen LW, Castellanos S, Joshi N, Satterwhite S, Knight KR. “The idea is to help people achieve greater success and liberty”: a qualitative study of expanded methadone take-home access in opioid use disorder treatment. Subst Abus 2022; 43: 1143–50. doi: 10.1080/08897077.2022.2060438.
Kleinman RA, Sanches M. Methadone-involved overdose deaths in the United States before and during the COVID-19 pandemic. Drug Alcohol Depend 2023; 242: 109703. doi: 10.1016/j.drug alcdep.2022.109703.
Hatch-Maillette MA, Peavy KM, Tsui JI, Banta-Green CJ, Woolworth S, Grekin P. Re-thinking patient stability for methadone in opioid treatment programs during a global pandemic: provider perspectives. J Subst Abuse Treat 2021; 124: 1082 23. doi: 10.1016/j.jsat.2020.108223.
Levander XA, Hoffman KA, McIlveen JW, McCarty D, Terashima JP, Korthuis PT. Rural opioid treatment program patient perspectives on take-home methadone policy changes during COVID-19: a qualitative thematic analysis. Addict Sci Clin Pract 2021; 16: 72. doi: 10.1186/s13722-021-00281-3.
Treitler PC, Bowden CF, Lloyd J, Enich M, Nyaku AN, Crystal S. Perspectives of opioid use disorder treatment providers during COVID-19: adapting to flexibilities and sustaining reforms. J Subst Abuse Treat 2021; 132: 108514. doi: 10.1016/j.jsat.2021.108514.
Office of the National Economic and Social Development Board and Office of the Prime Minister. The thirteenth National Economic and Social Development Plan (2023-2027) [online]. 2023 [cited Feb 29, 2024] Available from: www.nesdc.go. th/main.php?filename=plan13.
Copeland S, Hinrichs-Krapels S, Fecondo F, Santizo ER, Bal R, Comes T. A resilience view on health system resilience: a scoping review of empirical studies and reviews. BMC Health Serv Res 2023; 23: 1297. doi: 10.1186/s12913-023-10022-8.
Dooley J, Asbridge M, Fraser J, Kirkland S. Physicians' attitudes towards office-based delivery of methadone maintenance therapy: results from a cross-sectional survey of Nova Scotia primary-care physicians. Harm Reduct J 2012; 13: 20. doi: 10.1186/1477-7517-9-20.
Luo S, Lin C, Feng N, Wu Z, Li L. Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China. Int J Drug Policy 2019; 71: 73-7. doi: 10.1016/j.drugpo.2019.06.005.
Deren S, Kang S-Y, Mino M, Seewald RM. Attitudes of methadone program staff toward provision of harm-reduction and other services. J Addict Med 2012; 5: 289-92. doi: 10.1097/ADM.0b013e31821dc61a.
World Health Organization. An integrated approach to building health systems resilience [online]. 2024 [cited Apr 1, 2024]. Available from: openwho.org/ courses/health-service-resilience.
Calcaterra SL, Dafoe A, Tietbohl C, Thurman L, Bredenberg E. Unintended consequences of methadone regulation for opioid use disorder treatment among hospitalized patients. J Hosp Med 2024; 19: 460-7. doi: 10.1002/jhm.13329.
World Health Organization. Health system resilience indicators: an integrated package for measuring and monitoring health system resilience in countries. Geneva: World Health Organization; 2024.
