Patients on Opioid Substitution Treatment in the Republic of Macedonia: What Do Treatment Demand Data Tell Us?

Tatjana Petrushevska; Vesna Velik Stefanovska

doi:10.3889/oamjms.2014.058

Authors

Tatjana Petrushevska Ministry of Health of the Republic of Macedonia, Skopje
Vesna Velik Stefanovska Institute for Epidemiology and Medical Biostatistics, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje

DOI:

https://doi.org/10.3889/oamjms.2014.058

Keywords:

OST, patient demographic characteristics, poly drug use, living status, heroin use, MMT.

Abstract

AIM: The aim of the survey is to analyze national data from opioid substitution treatment (OST) medical records and to compare it with the data from EU countries.

MATERIAL AND METHODS: The survey is quantitative analytical cross-sectional study conducted in the period September - December 2013. Medical records from all patients on OST at national level during the year 2012 were analyzed. EMCDDA questionnaire from treatment protocol 3.0 was used. Data for OST patients on MMT was take from all 12 public treatment facilities, three private centers and 3 prisons. Data for OST patients on buprenorphine was taken from public clinic as the only one responsible for this type of treatment.

RESULTS: A comprehensive network, diverse models of treatment intervention exists in the MKD. Total number of OST patients in 2012 in all treatment facilities was 1857 (1356 are in public, 141 in private, 360 in prison settings) 10% are on Buprenorphine and 90% are on Methadone, 52% in age group 20-34. Ratio of male to female heroin clients is 9:1; 162 are female (9 %); 107(66%) are in treatment in the age group 20-34. Average number of OST patients is 0.1% of the total population in each of the 10 cities analyzed. The mean age at first heroin use is 18 years. 40% of patients havenâ€™t high school. With their family lives 65% of OST patients; 487 patients (36%) have children; 80% of patients use of benzodiazepines.

CONCLUSION: Although treatment network of drug addiction is quite developed, perceived need for further capacity building and increase the quality of medical care implies increasing the availability, diversification in terms of sensitivity to cultural differences, gender, age, ethnicity, as well as the treatment of dependence of different types of psychoactive substances.

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References

UNODC: The Global Afghan Opium Trade, A Threat Assessment, 2011.

Dimovski Z, Babanoski K, Ilijevski I. Republic of Macedonia as a Transit Country for the Illegal Trafficking in the â€œBalkan Routeâ€. Varstvoslovje, Journal of Criminal Justice and Security, 2012;15(2): 203â€“217.

http://www.emcdda.europa.eu/themes/key-indicators/pdu

Perspectives on drugs, Trends in heroin use in Europe: what do treatment demand data tell us? Emcdda, updated 28. 5. 2013, http.//www.emcdda.europa.eu/topics/ pods/trends-in-heroin-use

Effectiveness of drug dependence treatment in preventing HIV among injecting drug users. Geneva: World Health Organization, 2005. http://www.who.int/hiv/pub/idu/en/drugdependencefinaldraft.pdf

National Institutes of Health National Institute on Drug Abuse. July7, 2011. http://www.drugabuse.gov/ScienceofAddiction/addiction.html.

Robinson TE, Berridge KC. Brain Res Rev.1993;18(3):247-291. DOI: https://doi.org/10.1016/0165-0173(93)90013-P

Oâ€™Brien CP, McLellan AT. Lancet. 1996;347(8996):237-240. DOI: https://doi.org/10.1016/S0140-6736(96)90409-2

McLellan AT et al. JAMA. 2000;284(13):1689-1695. DOI: https://doi.org/10.1001/jama.284.13.1689

Weber R et. al. Uptake of and virological response to antiretroviral therapy among HIV-infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study. HIV Medicine. 2009;10(7):407â€“416.

World Drug Report 2012 - United Nations Office on Drugs and Crime http://www.unodc.org/doc/wdr/Chp1_A.pdf

Michelle Kermode, Nick Crofts, M Suresh Kumar & Jimmy Dorabjee Opioid substitution therapy in resource-poor settings. Bulletin of the World Health Organization. 2011;89:243-243. DOI: https://doi.org/10.2471/BLT.11.086850

Lawrinson P, Ali R, Buavirat A, Chiamwongpaet S, Dvoryak S, Habrat B, et al., et al. Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction. 2008; 103: 1484-92.

Gowing L, Farrell M, Bornemann R, Sullivan LE, Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev. 2008; 2: CD004145-. DOI: https://doi.org/10.1002/14651858.CD004145.pub3

Weber R, Huber M, Rickenbach M, Furrer H, Elzi L, Hirschel B, et al., et al. Uptake and virological response to antiretroviral therapy among HIV infected former and current injecting drug users and persons in an opiate substitution treatment program: the Swiss HIV Cohort Study. HIV Med. 2009; 10: 407-16. DOI: https://doi.org/10.1111/j.1468-1293.2009.00701.x

R. Kathryn McHugh, Bridget A. Hearon, and Michael W. Otto. Cognitive-Behavioral Therapy for Substance Use Disorders Psychiatr Clin North Am. 2010; 33(3): 511â€“525. DOI: https://doi.org/10.1016/j.psc.2010.04.012

Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess. 2007; 11: 1â€“171, iiiâ€“iv. DOI: https://doi.org/10.3310/hta11090

Joseph H, Stancliff S, Langrod J.Methadone maintenance treatment (MMT): a review of historical and clinical issues. Mt Sinai J Med. 2000;67(5-6):347-64.

Lawrinson P, Ali R, Buavirat A, Chiamwongpaet S, Dvoryak S, et al. Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction. 2008;103: 1484â€“1492. DOI: https://doi.org/10.1111/j.1360-0443.2008.02249.x

Gruber SA, Tzilos GK, Silveri MM, Pollack M, Renshaw PF, Kaufman MJ, Yurgelun-Todd. Methadone maintenance improves cognitive performance after two months of treatment. Clin Psychopharmacol. 2006; 14(2):157-64. DOI: https://doi.org/10.1037/1064-1297.14.2.157

De Maeyer J, Vanderplasschen W, Camfield L, Vanheule S, Sabbe B, Broekaert E.A good quality of life under the influence of methadone: a qualitative study among opiate-dependent individuals. Int J Nurs Stud. 2011;48(10):1244-57. DOI: https://doi.org/10.1016/j.ijnurstu.2011.03.009

Effectiveness of drug dependence treatment in preventing HIV among injecting drug users. Geneva: World Health Organization; 2005. Available from: http://www.who.int/hiv/pub/idu/en/drugdependencefinaldraft.pdf

Raffa JD, Grebely J, Tossonian H, Wong T, Viljoen M, et al. The impact of ongoing illicit drug use on methadone adherence in illicit drug users receiving treatment for HIV in a directly observed therapy program. Drug Alcohol Depend. 2007; 89: 306â€“309. DOI: https://doi.org/10.1016/j.drugalcdep.2007.02.007

Nosyk B, Marsh DC, Sun H, Schechter MT, Anis AH. Trends in methadone maintenance treatment participation, retention, and compliance to dosing guidelines in British Columbia, Canada: 1996â€“2006. J Subst Abuse Treat. 2010; 39: 22â€“31. DOI: https://doi.org/10.1016/j.jsat.2010.03.008

Liu E, Liang T, Shen L, Zhong H, Wang B, et al. Correlates of methadone client retention: a prospective cohort study in Guizhou province, China. Int J Drug Policy. 2009; 20: 304â€“308. DOI: https://doi.org/10.1016/j.drugpo.2008.09.004

Banta-Green CJ, Maynard C, Koepsell TD, Wells EA, Donovan DM. Retention in methadone maintenance drug treatment for prescription-type opioid primary users compared to heroin users. Addiction. 2009; 104: 775â€“783. DOI: https://doi.org/10.1111/j.1360-0443.2009.02538.x

Soyka M, Zingg C, Koller G, Kuefner H. Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study. Int J Neuropsychopharmacol. 2008; 11: 641â€“653. DOI: https://doi.org/10.1017/S146114570700836X

Reingardiene D, JodziÅ«niene L, Lazauskas R. Methadone treatment and its dangers. Medicina (Kaunas). 2009; 45(5):419-25. DOI: https://doi.org/10.3390/medicina45050053

World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.I), p.11.

Discussion paper UNODC/WHO 2013. Opioid overdose: preventing and reducing, opioid overdose mortality, Contribution of the United Nations Office on Drugs and Crime and the World Health Organization to improving responses by Member States to the increasing problem of opioid overdose deaths. UN, New York, 2013.

World Health Organization, Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence (Geneva, 2009).

Stauffacher M. Drug treatment data as an epidemiological indicator indicator: methodological considerations Bulletin on Narcotics, United Nations Journal. The science of drug abuse epidemiology. 2002; (vol. LIV, No.1 and 2)

Montanari L et al. Treatment demand indicator (TDI) Standard Protocol 3.0.Guedlines for reporting data on people entering drug treatment in European countries. EMCDDA. 2012.

Population estimates, 31.12.2011, by sex, age and statistical regions. State Statistical Office of the Republic of Macedonia, 2012.

Women and men in the Republic of Macedonia, 2012 Republic of Macedonia, State Statistical Office Publisher: The State Statistical Office, Skopje, Dame Gruev 4, 2012.

EMCDDA Perspectives on drugs, Trends in heroin use, in Europe includes the 27 EU Member States, Croatia, Turkey and Norway, 2013.

Schiff M, Levit S, Moreno RC. Retention and illicit drug use among methadone patients in Israel: a gender comparison. Addictive Behaviors. 2007;32:2108â€“2119. DOI: https://doi.org/10.1016/j.addbeh.2007.01.010

Fischer G., StÃ¶ver H. Assessing the current state of opioid-dependence treatment across Europe: methodology of the European Quality Audit of Opioid Treatment (EQUATOR) project. Heroin Addict Relat Clin Probl. 2012; 14: 5-70.

GoulÃ£o J, StÃ¶ver H. The profile of patients, out-of-treatment users and treating physicians involved in opioid maintenance treatment in Europe. Heroin Addict Relat Clin Probl. 2012; 14(4): 7-22.

EMCDDA: Statistical bulletin 2012. www.emcdda.europa.eu//stats12/list.

Roncero C. on behalf of the PROTEUS Study investigators: Therapeutic management and comorbidities in opiate-dependent patients undergoing a replacement therapy programme in Spain: the PROTEUS study. Heroin Addict Relat Clin Probl. 2011; 13: 5-16.

Jones A, Weston S, Moody A, Millar T, Dollin L, Anderson T, Donmall M. The Drug Treatment Outcomes Research Study (DTORS): Research Report 3. 2007. www.dtors.org.uk

Wittchen HU, BÃ¼hringer G, Rehm J. Ergebnisse und Schlussfolgerungen der Premos-Studie (Predictors, Moderators and Outcome of Substitution Treatment). Suchtmedizin in Forschung und Praxis. 2011; 13: 199-299.

GoulÃ£o J, Heino StÃ¶ver.The profile of patients, out-of-treatment users and treating physicians involved in opioid maintenance treatment in Europe. Heroin Addict Relat Clin Probl 2012; 14(4): 7-22

www.emcdda.europa.eu

Wittchen HU et al. Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: a naturalistic study in 2694 patients. Drug Alcohol Depend. 2008; 95: 245-257. DOI: https://doi.org/10.1016/j.drugalcdep.2008.01.015

Wittchen HU et al. Ergebnisse und Schlussfolgerungen der PREMOS-Studie (Predictors, Moderators and Outcome of Substitution Treatment). Suchtmedizin in Forschung und Praxis. 2011; 13: 199-299.

Roncero C, on behalf of the PROTEUS study investigators. Therapeutic management and comorbidities in opiate-dependent patients undergoing a replacement therapy programme in Spain: the PROTEUS study. Heroin Addict Relat Clin Probl. 2011; 13: 5-16.

Jones A, et al. The Drug Treatment Outcomes Research Study (DTORS): baseline report. Research Report 3. 2007. www.dtors.org.uk. DOI: https://doi.org/10.1037/e420772008-001

Cloud W, Granfield R. Conceptualizing recovery capital: expansion of a theoretical construct. Subst Use Misuse. 2008; 43: 1971-1986. DOI: https://doi.org/10.1080/10826080802289762

Kuzmanovska G. Mikik V. Stojanovik S. Report from the assessment of population size of injecting drug users in Kumanovo, Gostivar, Strumica, Ohrid and Skopje,Institute of Public Health, Department for Control and Prevention of Communicable Diseases and Joint Un program on HIV/AIDS â€“Skopje, 2010.

GoulÃ£o J, StÃ¶ver H. The profile of patients, out-of-treatment users and treating physicians involved in opioid maintenance treatment in Europe. Heroin Addict Relat Clin Probl. 2012; 14(4): 7-22.

Brady TM, Ashle OS. Women in Substance Abuse Treatment: Results from the Alcohol and Drug Services Study (ADSS) Department of Health and human services. Substance Abuse and Mental Health Services Administration Office of Applied Studies, September 2005. http://www.oas.samhsa.gov

Boutwell AE, et al. Arrested on heroin: A national opportunity. Journal of Opioid Management. 2007; 3:328-32. DOI: https://doi.org/10.5055/jom.2007.0021

Marzo JN, et al. Maintenance therapy and 3-year outcome of opioid dependent prisoners: A prospective study in France (2003-2006).Addiction. 2009;104:1233-40. DOI: https://doi.org/10.1111/j.1360-0443.2009.02558.x

McMillan GP, Lapham S, Lackey M. The effect of a jail methadone maintenance therapy (MMT) program on inmate recidivism. Addiction. 2008; 103:2017-23. DOI: https://doi.org/10.1111/j.1360-0443.2008.02361.x

Hunt G, Evans K, Moloney M, Bailey N. Combining different substances in the dance scene: enhancing pleasure, managing risk and timing effects. J Drug Issues. 2009; 39: 495-522. DOI: https://doi.org/10.1177/002204260903900303

Lankenau SE, Clatts MC. Patterns of Polydrug Use among Ketamine Injectors in New York City. Subs Use Misuse. 2005; 40: 1381-1397. DOI: https://doi.org/10.1081/JA-200066936

Klein H, Elifson KW, Sterk CE. Young adult Ecstasy userâ€™s enhancement of the effects of their ecstasy use. J Psychoactive Drugs. 2009; 41: 113-120. DOI: https://doi.org/10.1080/02791072.2009.10399904

Fischer G et al. The non-medical use of prescription drugs Policy direction issues, United Nations Office on Drugs and crime, New York, 2011.

Lintzeris N et al. Pharmacodynamics of diazepam co-administered with methadone or buprenorphine under high dose conditions in opioid dependent patients. Drug and Alcohol Dependence. 2007; 91: 187â€“194. DOI: https://doi.org/10.1016/j.drugalcdep.2007.05.019

Kandel D, Huang FY, Davies M. Comorbidity between patterns of substance use dependence and psychiatric syndromes. Drug Alcohol Depend. 2001; 64: 233â€“241. DOI: https://doi.org/10.1016/S0376-8716(01)00126-0

Brands B, Blake J, Marsh DC, Sproule B, Jeyapalan R, Li S. The impact of benzodiazepine use on methadone maintenance treatment outcomes. J Addict Dis. 2008;27(3):37-48. DOI: https://doi.org/10.1080/10550880802122620

Simoni-Wastila L, Ritter G, Strickler G. Gender and other factors associated with the nonmedical use of abusable prescription drugs. Subst Use Misuse. 2004;39(1):1â€“23. DOI: https://doi.org/10.1081/JA-120027764

Blanco C, Alderson D, Ogburn E, et al. Changes in the prevalence of non-medical prescription drug use and drug use disorders in the United States. Drug Alcohol Depend. 2007;90(2â€“3):252â€“60. DOI: https://doi.org/10.1016/j.drugalcdep.2007.04.005

Gaulier JM, Marquet P, Lacassie E, Dupuy JL, Lachatre G. Fatal intoxication following selfâ€administration of a massive dose of buprenorphine. Journal of Forensic Sciences. 2000;45(1):226â€“228. DOI: https://doi.org/10.1520/JFS14667J

http://www.incb.org/incb/en/narcotic-drugs/Technical_Reports/narcotic_drugs_reports.html

Health care program for people with addictions in RM 2012 Official Gazette no. 8 , 2012.

Form C 2012 for The Republic of Macedonia. INCB, Annual Statistics of production, manufacture, consumption, stocks and seizures of Narcotic drugs, Single Convention on Narcotic Drugs of 1961: articles 1, 2, 13, 20 and 27, 1972. Protocol amending the Single Convention on Narcotic Drugs of 1961: articles 1 and 10. Ministry of Health of the Republic of Macedonia, 2012.