“It’s like ‘liquid handcuffs”: The effects of take-home dosing policies on Methadone Maintenance Treatment (MMT) patients’ lives

Harm Reduction Journal

Laura Curran¹  David Frank²  Suzan M. Walters³  Pedro Mateu-Gelabert⁴  Honoria Guarino⁴  David C. Perlman⁵ 

[1] Behavioral Science Training in Drug Abuse Research, NYU Rory Meyers College of Nursing, 380 2nd Avenue, Suite 306, 10010, New York City, NY, USA;Behavioral Science Training in Drug Abuse Research, NYU Rory Meyers College of Nursing, 380 2nd Avenue, Suite 306, 10010, New York City, NY, USA;Center for Drug Use and HIV/HCV Research, NYU School of Global Public Health, New York City, NY, USA;Center for Drug Use and HIV/HCV Research, NYU School of Global Public Health, New York City, NY, USA;School of Global Public Health, New York University, New York City, NY, USA;Graduate School of Public Health and Health Policy, City University of New York, New York City, NY, USA;Icahn School of Medicine at Mount Sinai, New York, NY, USA;

关键词: Methadone Maintenance Treatment (MMT);    Take-home doses;    Methadone clinics;    Harm reduction;    Patients’ rights;    Stigma;   

DOI  :  10.1186/s12954-021-00535-y

来源: Springer

【 摘 要 】

BackgroundMethadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing risk of overdose, arrest, and transmission of blood-borne viruses like HIV and HCV among people that use opioids. Yet, MMT’s use of restrictive take-home dose policies that force most patients to attend their clinic on a daily, or near-daily, basis may be unpopular with many patients and lead to low rates of treatment uptake and retention. In response, this article examines how clinics’ take-home dosing policies have affected patients’ experiences of treatment and lives in general.MethodsThis article is based on semi-structured, qualitative interviews with a variety of stakeholders in MMT. Interviews explored: reasons for engaging with, or not engaging with MMT; how MMT is conceptualized by patients and treatment providers (e.g., as harm reduction or route to abstinence and/or recovery); experiences with MMT; perception of barriers to MMT (e.g., organizational/regulatory, social) and how MMT might be improved to support peoples’ substance use treatment needs and goals.ResultsNearly all of the patients with past or present MMT use were highly critical of the limited access to take-home doses and consequent need for daily or near daily clinic attendance. Participants described how the use of restrictive take-home dose policies negatively impacted their ability to meet day-to-day responsibilities and also cited the need for daily attendance as a reason for quitting or avoiding OAT. Responses also demonstrate how such policies contribute to an environment of cruelty and stigma within many clinics that exposes this already-stigmatized population to additional trauma.ConclusionsTake-home dose policies in MMT are not working for a substantial number of patients and are reasonably seen by participants as degrading and dehumanizing. Revision of MMT regulations and policies regarding take home doses are essential to improve patient satisfaction and the quality and effectiveness of MMT as a key evidence-based treatment and harm reduction strategy.

【 授权许可】

CC BY