UCLA

Background: Social support has been studied by a series of authors as a factor to improve treatment outcome of MMT. The influence of social support could be much more profound in a country like China which has a family-oriented culture. As partnership status (e.g. whether living with a regular partner and/or drug use status of the regular partner) are potentially strong predictors for treatment outcome of MMT, the impact of these factors remains poorly understood. In this study, we aimed to test the hypothesis that living with a drug-using regular sex partner was associated with higher odds to drop out of treatment and increased probability of ongoing substance use while maintained on treatment. We also aimed to find out how actively the regular sex partners had been involved with the treatment support, and to identify the benefits brought by MMT to them and their relationship with the drug user and what the challenges remained for better support.

Method: The study was conducted in two provinces in central China. The study was comprised of a qualitative section and a quantitative section. For the qualitative study, 20 patients were recruited from five participating clinics. As 5 of the 20 participants were single, we were able to recruit a total of 15 regular sex partners. The patients and their partners were in-depth interviewed separately. For the quantitative study, a survey was administrated using ACASI in a private room at each clinic with 500 patients recruited from 20 randomly selected clinics. Three and six months after the baseline survey, the treatment status, most recent urine test result for drug use and most recent HIV test result was collected.

Results: Participants who had a drug-using regular sex partner were less likely to continue to use substance at 3-months and they were also were less likely to stay in treatment at 6 months after enrollment. Participants who received a higher dose of methadone were less likely to be retained at 3-months. All participating partners had a good experience with methadone by observing the improvement in both physical and psychological health of their partners who had enrolled. The financial burden brought by substance use was greatly relieved. The drug-using partners who had not yet enrolled for MMT themselves planned to enroll after seeing the improvement of their partners. Some partners had played their part in reducing the occurrences of continued drug uses. The overall acceptance of long-term adherence among new patients and their partners was low. Rumors about use of methadone would damage one's kidney and liver were commonly believed by both the patients and their partners. On the other hand, during their short course in treatment the patients and their partners showed high level of satisfaction towards the effectiveness of MMT and the quality of service received. A daily visit to the MMT clinic and cost of medication was logistically manageable for most patients.

Conclusion: We urge the staff at MMT clinics to pay special attention on the concordant drug-using couples as they are at greater risk for relapse and drop out in the long run. Special counseling for couples would be helpful. The staff at MMT clinics should work closely with the partners for improved treatment outcomes. The partners are the key contact person to be reached in case a patient starts being absent from treatment. The partners should then be included in the educational programs held at the clinics. The programs also provide the partners an opportunity to meet one another and exchange ideas for better support. Training of the clinic staff is necessary for them to better understand the nature of methadone and how it works then they could better educate their patients. The popular opinion leader approach could be considered to counter the rumors of methadone's bad side effect. The first few months in treatment are vitally important for long-term adherence and therefore the best possible time to educate the patients and partners about the importance of the maintenance nature of MMT.