The effect of methadone maintenance treatment program
(mmtp) on harm reduction
ABSTRACT
Methadone Maintenance Treatment
Program (MMTP) is one of the harm
reduction program. MMTP is expected
to reduce drug use, risk behavior,
crime, and increase productivity, living
conditions, and family support for
injecting drug users (IDUs). MMTP in
Yogyakarta has been implemented
since 2006. Currently have been
provided four MMTP satellite services
are: Grhasia hospital, Gedongtengen
primary health care (PHC), Umbulharjo
I PHC and Banguntapan II PHC. As of
November 2012 there were 39 actively
registered patients (35 males, 4
females). This study aimed to
determine the impact of MMTP on
patients, including a reduction in drug
use, risk behavior, crime, and increase
productivity, housing conditions, and
family support in the MMTP satellite
services Yogyakarta. This study was
descriptive research with case study
design and cross-sectional approach.
This research conducted in October -
December 2012. Subjects were 32
MMTP active patients. 88% reduction
in drug use, 97% were not involving in
criminal activity, 100% reduction in
criminal behaviours, 81% improvement
in employment status.The analysis
result of of Pearson correlation was
found significance level of 0,001 (<
0,05). With relationship value of 0,588.
There was a significant positive
relationship between MMTP services
with the impact of MMTP on patients.
Keywords: harm reduction,
methadone, MMTP
CONTACT
Julaeha, MPH., Apt
17 Agustus 1945 Jakarta University
Email: julqoz87@gmail.com
Phone: 6281392932832
Website:
Julaeha1,*, Rustamaji2, Nunung Priyatni2 Sani Nur Baeti3
1Faculty of Pharmacy, 17 Agustus 1945 University Jakarta, Indonesia
2Faculty of Medicine, Gadjah Mada University Yogyakarta, Indonesia
3Gedongtengen Primary Health Care Yogyakarta, Indonesia
INTRODUCTION
An increasing number of injecting drug users (IDUs)
are very fast in recent years has reached an worrying
stage and it is followed by health and social problems
associated with it. In recent years, drug problems is
compounded by the spread of HIV / AIDS, Hepatitis B
and C significantly among IDUs. An estimated number
of drug users around the world in 2005/2006 there
were 200 million people, while in the year 2006/2007
increased to 208 million people. With this fact, it is
estimated that the growth rate of drug abusers there
were 0.04 per year. In Indonesia, the number of drug
abusers about 3.3 million people in 2008, and will
increase to 4.5 million people in the year 2013.1 In
Indonesia, the number of injecting drug users (IDUs)
around 236,172 people in 2008, and will increase to
312,909 people in 2013.1
On June 2011, according to the Ministry of Health
report, the number of cumulative AIDS cases reported
were 26.483 cases. From the 26.483 cases of AIDS, a
total of 9.597 cases of AIDS are IDUs. Sharing needles
is the second highest risk factor after heteroseksual.
The age range 20-29 years was the highest number.2
Yogyakarta is included in the top 10 provinces with the
highest cumulative cases of AIDS as of June 2011. In
2009, the total number of AIDS cases in Yogyakarta is
about 246 cases, 119 cases were IDUs.2
Harm reduction programs due to injecting drug use is
necessary. One of the harm reduction approach is
Methadone Maintenance Treatment Program (MMTP).
The goal of MMTP are to reduction of drug use, high-
risk behavior, criminal behaviour, increase productivity,
family support, and housing conditions. The
implementation of Methadone Maintenance Therapy
Program (MMTP) is carried out in the long term and
involves the role of medical and non-medical personnel
in its implementation. Until now the impact of MMTP in
Yogyakarta on harm reduction for MMTP active clients
still unknown. So for the determine achievement of
MMTP goals is a necessary related study of MMTP
impact on MMTP patients.
METHODS AND MATERIALS
This study is a descriptive with case study research
design.. This study was conducted in October -
December 2012. The population included in this study
were 32 active PTRM patients from a total of 39 active
patients. With inclusion criteria, all active MMTP
patients have been registered as PTRM patients until
November 2012, who have attended MMTP for at least
1 month. Exclusion criteria from this study were PTRM
patients who refused to participate in the study.
MMTP satellite service ∑ active ∑ patient
patient included
Grhasia Hospital 8 8
Umbulharjo I PHC 5 4
Gedongtengen PHC 17 14
Banguntapan II PHC 9 6
Total 39 32
Table 1. Number of Participants
The instrument in this study uses a questionnaire
adopted from Evaluating of Methadone Maintenance
Treatment Service. First Voice, Capital Health Addiction
Prevention and Treatment Service. Interview
guidelines, and document observation sheets. The data
needed in this study were obtained from medical
records of MMTP patients, questionnaire sheets,
observation sheets and interview results. Pearson
correlation analysis was performed to determine the
relationship between the MMTP service
implementation with effects of MMTP on MMTP
patients.
RESULTS
1. Demographics of Participants
Based on gender, the majority of MMTP patients were male.
By age group, 25-49 age group is the largest age group.
Based on the level of education, PTRM patients with a high
school education level were the highest in the
Gedongtengen health center, Banguntapan II health center
and RSJ. Grhasia. Based on marital status, the majority of
patients in all four satellite PTRM satellites are married.
Based on domicile, the majority of PTRM patients live in the
city of Jogja. The number of patients withTRM who received
ARV therapy was 10 patients.
2. MMTP Services
MMTP service generally can be categorized into methadone
services and non-methadone services. Achievement of
methadone services regarding explanation of drinking
methadone in place and take home dose (THD) reached
91% and 97%. Explanation of PTRM before the patient
decides to take part in a 100% PTRM. The achievement of
the smallest service is counseling about the importance of
voluntary HIV counseling testing (VCT) with an attainment
of 81%.
3. Effects of MMTP
The impact of MMTP on MMTP patients assessed in this
study is drug abuse, risk behavior, criminal behavior,
productivity, housing and family support.The sequence out
of the most widely impact perceived by participants was
reduced criminal behavior, reduced risk behaviors,
improved housing conditions, increased family support,
increased productivity and reduced drug usage.
Table 2. Demographics of Patient
not using drug 53
reduction in drug use
not sharing needles
not using needles
did not involved crime
decrease criminal behaviours
an improvement in employment status
an improvement in housing conditions
had family support
an increase in family support
Chart 1. Effects of MMTP
explanation taking methadone in place
explanation of take home dose
explanation of MMTP
medical examination
laboratory examination
participate in the group discussion
counseling on VCT
medication adherence counseling
counseling on HIV / AIDS
counseling on drug abuse
Chart 2. MMTP Services Achievement
DISCUSSION
The high number of participants who are still using drugs other
than methadone (47%), this is due to the lack of strong
motivation of participants PTRM to quit drugs. Moreover, judging
from the character of drug use by IDUs in Yogyakarta are multi
drug, addiction to heroin IDUs are recreational. Drug use among
IDUs who participated in MMTP affect adherence in methadone
treatment and be one cause of drop out from MMTP.3,4 The
longer the IDUs followed MMTP, it will be more reduce the
number of drug use. The types of drugs used by PTRM patients
are heroin, benzodiazepines, THC, methamphetamine, and
alcohol. Benzodiazepines are the most widely used drug by
PTRM patients. Patients using benzodiazepines were 11
patients. The high number of uses of benzodiazepines (BZD) by
MMTP patients, because BZD is a type of drug that can be
obtained legally by prescription. The reason for using BZD is to
overcome psychiatric disorders suffered by MMTP patients, such
as insomnia and anxiety. that the use of BZD at the start of
methadone therapy is associated with physical health problems
and psychosocial functioning.6
High-risk behaviors which assessed in this study is the use of
needles. The impact of a reduction in high-risk behavior by
MMTP gives good results, so this proves that MMTP major role
in the prevention of HIV / AIDS through the use of unsterilized
needles. Reducing risk behavior of the use of non-sterile needles
cannot be linearly related to the reduction in drug use by
participants, this is because the characteristics of drug use by
IDU in Yogyakarta are multi-drug.
There are 3 factors that influence the participation of patients in
MMTP. These three factors are participant factors, program
factors, and social factors. The patient's factor is motivation in
joining MMTP. motivation to follow the program can be
categorized as internal and external motivation. Program factors
can be in the form of ease of procedure in joining MMTP, level of
satisfaction with MMTP and MMTP officers, ease of accessing
MMTP locations, and attitudes of PTRM officers. Social factors
can be in the form of family support, peer support, and support
for the surrounding environmental environment.11,12The absence
or lack of family support is one of the external factors that have
dropped out of participating in MMTP.10
From the results of Pearson correlation analysis with 95%
confidence level obtained correlation value 0.588. Positive
correlation value means that there is a positive relationship
between MMTP services and MMTP effects on patients. The
closeness of the relationship is strong because the correlation
value is more than 0,5.
CONCLUSIONS
Methadone Maintenance Treatment Program (MMTP) is useful
in harm reduction due to injecting drug use. causes of drop out
from the program is the low internal motivation in following
MMTP.
ACKNOWLEDGEMENTS
The authors wish to thank all participating patients, physicians,
social workers and pharmacists from grhasia hospital,
gedongtengen primary health care, umbulharjo I primary health
care and banguntapan II primary health care
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