Is needle exchange programme still relevant in the advent of Methadone maintanence Therapy?

Nurulhuda, M. and Khairi, C.M. and Norwati, D. (2018) Is needle exchange programme still relevant in the advent of Methadone maintanence Therapy? In: 3rd AMDI International Biohealth Sciences Conferences 2018, 01 Jun 2018, Kuching, Sarawak, Malaysia.

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Abstract

Aims: This study aims to determine the prevalence of relapse in those receiving MMT and study the harmful practices done during the relapses with their perceived causes. Background: Substance abuse is both a social and public health problem with a substantial burden to society. Opioid dependence, with an estimated prevalence of 16.5 million worldwide, carries a high cost to society by resulting in unemployment, crimes and family disruption; not to mention transmission of diseases such as HIV and Hepatitis C. In Malaysia, there is an estimated 234 000 heroine abusers.Harm reduction practices, namely Methadone Maintenance Therapy (MMT) and needle exchange programme has been in Malaysia since 2005. For MMT, relapse during treatment remains an issue that hinders successful outcome of reducing transmission of blood-borne infections. Methods: This is a mixed-method cross-sectional study done from June-July 2016. All MMT clients in primary care therapy centres in Kuala Nerus district, Terengganu, Malaysia who fulfilled the inclusion and exclusion criteria and consented were included. A semi-structured questionnaire was filled via face-to-face interview and reference to the case records was done. 122 questionnaires were assessed. Ethical clearance was obtained from National Medical Research Ethics Committee (Ref 5-2307-27817). Results: Response rate was 90.2%. All respondents were males of Malay race. Mean age was 36.2. Mean duration in MMT was 1.4 years. Current relapse, defined as any episode of intake of heroine for the past one month after a period of abstinence was 34.4%. Of those relapsed, majority (78.6%) had Hepatitis C, 19.0% had HIV. Majority (97.6%) deny sharing needles during relapse. All attributed this due to ease of accessibility of needle exchange programme, and ability to withstand the urge for injection until getting a clean needle due to taking methadone. 50.8% still shared needle-washing containers despite non-sharing needles, all unaware that this may spread infections. Those who shared needles had both HIV and hepatitis C, could not get any needle despite exchange programme nearby. Conclusion: Relapse in opioid addiction remains high in those receiving MMT. Education to avoid harmful injecting practices is important even in this group. To achieve aim of harm reduction, MMT and needle exchange programme need to go hand to minimize the transmission of blood-borne diseases during opioid re-injecting behaviour.

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