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Barriers to retention in methadone maintenance therapy among people who inject drugs in Bangkok, Thailand: a mixed-methods study

Overview of attention for article published in Harm Reduction Journal, September 2017
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Title
Barriers to retention in methadone maintenance therapy among people who inject drugs in Bangkok, Thailand: a mixed-methods study
Published in
Harm Reduction Journal, September 2017
DOI 10.1186/s12954-017-0189-3
Pubmed ID
Authors

Kanna Hayashi, Lianping Ti, Prempreeda Pramoj Na Ayutthaya, Paisan Suwannawong, Karyn Kaplan, Will Small, Thomas Kerr

Abstract

Methadone maintenance therapy (MMT) is a mainstay for treating opioid use disorder and preventing and managing HIV among people who inject drugs (PWID). While previous research suggested low dosing of methadone and high rates of discontinuation of MMT among PWID in Thailand, little is known about patients' lived experiences with MMT in this setting. Therefore, we conducted a mixed-methods study to examine barriers to retention in MMT among PWID in Bangkok, Thailand, with particular attention to methadone dosing. Bivariate statistics were used to analyze quantitative survey data collected from methadone-treated PWID between July and October 2011. Qualitative data collected through semi-structured interviews with 16 methadone-treated PWID between July 2011 and June 2012 were analyzed thematically, with a focus on individual-level, social-structural, and environmental barriers to accessing MMT. Among 158 survey participants, a median dosage of methadone was 30 mg/day (interquartile range 20-50). Of these, 15.8% reported having acquired street methadone due to low prescribed dosages of methadone and 19.0% reported recent syringe sharing. Qualitative interview data indicated some methadone provider-related barriers, including discouraging patients from using methadone due to it being a Western medicine, difficulty negotiating higher doses of methadone, and abrupt dose reductions without patient consultation (involving the provision of non-medicated "syrup" in some cases). Social-structural and environmental barriers to optimal MMT access included intense police surveillance of methadone clinics; and frequent incarceration of PWID and a lack of access to methadone in prisons. Among our sample of methadone-treated PWID, methadone dosages were suboptimal according to the international guidelines. Poor adherence to international guidelines for opioid agonist therapies, aggressive law enforcement, and a lack of methadone in prisons need to be addressed to optimize MMT and reduce harms associated with untreated opioid use disorder in Thailand.

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X Demographics

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 122 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 122 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 16 13%
Student > Bachelor 15 12%
Researcher 14 11%
Student > Ph. D. Student 12 10%
Other 7 6%
Other 17 14%
Unknown 41 34%
Readers by discipline Count As %
Medicine and Dentistry 24 20%
Social Sciences 13 11%
Nursing and Health Professions 12 10%
Psychology 9 7%
Pharmacology, Toxicology and Pharmaceutical Science 5 4%
Other 14 11%
Unknown 45 37%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 April 2019.
All research outputs
#6,262,857
of 23,511,526 outputs
Outputs from Harm Reduction Journal
#615
of 965 outputs
Outputs of similar age
#96,789
of 316,630 outputs
Outputs of similar age from Harm Reduction Journal
#15
of 21 outputs
Altmetric has tracked 23,511,526 research outputs across all sources so far. This one has received more attention than most of these and is in the 73rd percentile.
So far Altmetric has tracked 965 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 28.8. This one is in the 36th percentile – i.e., 36% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 316,630 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 69% of its contemporaries.
We're also able to compare this research output to 21 others from the same source and published within six weeks on either side of this one. This one is in the 33rd percentile – i.e., 33% of its contemporaries scored the same or lower than it.