To evaluate the accessibility to a Montreal low-threshold methadone program (Relais-Méthadone). This program is aimed at a marginalized population of heroin addicts who are injection drug users (IDU).
The data (n = 141 clients) were collected during the first year of the program implementation with questionnaires administered by the programme workers.
Analysis of the characteristics of the clients revealed that the program does reach the target population. The program's clientele is characterized by long-time and frequent heroin use, unstable lifestyles, and the presence of numerous behaviours that put them at high risk for HIV transmission. The retention of clients in the program is very high (88%) within the first 30 days.
These results demonstrate the importance and value of flexible intervention programs in reaching a marginalized clientele exposed to the HIV virus, who would not have access to regular programs characterized by restrictive selection criteria and limited availability.
A day-by-day investigation of changes in criminal convictions before and after entering and leaving opioid maintenance treatment: a national cohort study.
Opioid maintenance treatment (OMT) is associated with reduced crime among heroin users, but little is known about how crime changes during different phases of treatment. The aim of this study was to investigate changes in criminal convictions on a day-to-day basis before and after entry or discharge from OMT.
National cohort study of all patients (n = 3221) in OMT in Norway 1997-2003. Patients were followed over a 9-year period, before, during, and after treatment. Criminal convictions were studied on a day-to-day basis in relation to treatment status. A time-continuous estimate of the probability of convictions within the population for all days during observation was calculated.
Changes in convictions were evident before changes of treatment status. During the 3 years prior to OMT, the convictions rate was approximately 0.4% per day. Prior to OMT, convictions decreased to about 0.2% per day on the day of treatment initiation. During the weeks before dropping out of treatment, convictions increased. The patterns during periods of transition were the same across gender, age and pre-treatment conviction-levels.
Changes in convictions often occurred prior to changes in treatment status. Reductions in criminal convictions were found in the period before entry (or re-entry) to OMT, and increases in criminal activity were found in the months prior to treatment interruption.
Notes
Cites: Drug Alcohol Depend. 2010 Apr 1;108(1-2):65-920022184
Cites: Drug Alcohol Depend. 2009 Nov 1;105(1-2):9-1519608355
'Non-compliant' individuals in opioid maintenance treatment, OMT, are often met with tight control regimes to reduce the risk of 'diversion', which may lead to harm or death among persons outside of OMT. This article explores reported practices of, and motivations for, diversion of methadone and buprenorphine, in a group of imprisoned individuals in OMT.
28 in-depths interviews were conducted among 12 OMT-enrolled, imprisoned individuals, most of whom were remand prisoners. All had experienced tight control regimes prior to imprisonment due to varying degrees of 'non-compliance' and illicit drug use during treatment. Their acquired norm of sharing with others in a drug using community was maintained when entering OMT. Giving one's prescription opioids to an individual in withdrawal was indeed seen as an act of helping, something that takes on particular significance for couples in which only one partner is included in OMT and the other is using illicit heroin. Individuals enrolled in OMT might thus be trapped between practicing norms of helping and sharing and adhering to treatment regulations. 'Diversion', as this term is conventionally used, is not typically understood as practices of giving and helping, but may nevertheless be perceived as such by those who undertake them.
As we see it, the need to sustain oneself as a decent person in one's own eyes and those of others through practices such as sharing and helping should be recognized. Treatment providers should consider including couples in which both individuals are motivated for starting OMT.
BACKGROUND: In Gjoevik, a Norwegian town with 28,000 inhabitants, general practitioners (GPs) have taken more responsibility for Methadone Maintenance Treatment (MMT) of heroin addicts than usual in Norway. We have assessed the treatment results in Gjoevik by comparing the fraction of patients who continue with treatment (retention in treatment, from 1999 to 2003), frequency of patient contact with professionals and the treatment outcome with the results for the rest of Norway. MATERIAL AND METHODS: In Norway, annual treatment results are reported for every MMT patient and the results are entered into a national register. This study is based on data in the national register from 2003. RESULTS: Retention is significantly higher in Gjoevik (93% vs. 77%) than in the rest of Norway. Patients have more contact with their GP in Gjoevik, while contact with local social service and so-called "responsibility groups" (organised cooperation between patient and professionals) are on the same level as for the country as a whole. The patients have less contact with specialized substance abuse and MMT centres than the average Norwegian patient. Treatment outcome regarding social rehabilitation (housing, source of income, occupation) and control of addictive behaviour (injecting drugs, opiate and illegal benzodiazepines in urine tests and overall assessment of drug behaviour) is close to the national average. INTERPRETATION: This may indicate that MMT programs with considerable delegation of treatment responsibility to GPs and local social service, can function as well as programs that rely more on specialised MMT-centres.
