By Thu Vuong, Alison Ritter, Marian Shanahan, Robert Ali, Nhu
Nguyen, Khue Pham, Thu T.A. Vuong and Le M. Giang.
In Vietnam, like many countries in East and Southeast Asia, the government has invested heavily in center-based compulsory treatment (CCT) as the mainstay demand reduction strategy for illicit drug use. This approach has been criticised on human rights grounds. Meanwhile, community-based voluntary methadone maintenance treatment (MMT) has been implemented for nearly a decade with promising results. To date, there have been no comparative Vietnamese studies of these approaches. The study, involving 208 CCT participants and 384 MMT participants with heroin dependence, was a combined retrospective and prospective observational study conducted over three years between 2012 and 2014 (with data at five time-points). The primary outcome was: self-report heroin use (confirmed by urinalysis). The four secondary outcomes were: illegal behaviours, overdose, blood-borne virus (BBV) risk behaviours, and monthly drug expenditure. Mixed effects regression analyses, which took into account baseline differences between the groups, were used to analyse the data. This study is registered with ClinicalTrials.gov, number NCT03071315.
The study found MMT was more strongly associated with four outcome measures compared to CCT (reduction in heroin use (β = 3.39, SE = 0.31, p < .0001) (equivalent to an odds ratio of 29.67 (95% CI 21.76–40.45)), reduction in illegal behaviours (β = 0.94, SE = 0.39, p < .0001), (equivalent to an odds ratio of 2.56 (95% CI 1.79–3.78)), reduction in BBV risk behaviours (β = 1.08, SE = 0.17, p < .0001), (equivalent to an odds ratio of 2.94 (95% CI 2.48–3.49)), and reduction in monthly drug spending (β = −VND1,515,200 (equivalent to US$72.00), SE = VND452,900, p < .0001)). The analyses did not support the hypothesis that MMT was associated with better outcomes pertaining to overdose (β = −0.27, SE = 0.30, p = .62), probably due to the infrequency of these self-reported events. Our observational study suggests that MMT is associated with greater reductions in heroin use, BBV risk behaviours, drug-related illegal behaviours, and monthly drug spending compared with CCT. In the context that the CCT approach has been criticized for human rights violations, this study provides evidence to support the scale up of MMT and the transition of CCT to voluntary community based treatment.