Opioid-Related Disorders
Conditions
Keywords
Malaysia, Asia, Southeast Asia, Compulsory Drug Detention Centers, Compulsory Centers for Drug Users, Methadone, Drug Relapse, Drug and Narcotic Control, Opiate Substitution Treatment, Prisons
Brief summary
This observational study compares the health and social outcomes between opioid-dependent individuals who are either recently released from a compulsory drug detention center (CDDC) or recently discharged from a voluntary treatment center (VTC) providing methadone maintenance therapy, in Malaysia.
Detailed description
In July 2010, the National Anti-Drug Agency of Malaysia (NADA) introduced a non-punitive system of treatment and care for people who use drugs, voluntary treatment centers (VTCs), called 'Cure & Care' clinics, offering free methadone maintenance therapy (MMT) to opioid-dependent drug users. These centers were opened alongside existing compulsory drug detention centers (CDDCs), where people who use drugs continue to be detained involuntarily without access to evidence-based treatment. Given that both of these programs are operated by NADA but espouse vastly different responses to drug use, we compared health and social outcomes between opioid-dependent individuals recently released from CDDCs and recently initiated into MMT in the new VTCs.
Interventions
DRUGMethadone
Sponsors
Yale University
World Bank
Doris Duke Charitable Foundation
National Institute of Mental Health (NIMH)
The University of New South Wales
Burnet Institute
University of Florida
National Institute on Drug Abuse (NIDA)
University of Malaya
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Meets Diagnostic and Statistical Manual-IV criteria for opioid dependence * Physically and psychologically capable of understanding and undergoing informed consent process * Within 90 days of release or discharge and intending to return to Klang Valley region * For VTC arm, came to the C&C to start MMT
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Occurrence of opioid use (urine-toxicology) | Year following release from CDDC or discharge from VTC |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Occurrence of buprenorphine use (urine-toxicology) | Year following release from CDDC or discharge from VTC | This is a proxy for linkage to buprenorphine therapy |
| Occurrence of any drug use (urine-toxicology) | Year following release from CDDC or discharge from VTC | Includes opioid, amphetamine and benzodiazepine use |
| Occurrence of no-methadone use (urine-toxicology) | Year following release from CDDC or discharge from VTC | This is a proxy for retention in methadone therapy |
| Occurrence of benzodiazepine use (urine-toxicology) | Year following release from CDDC or discharge from VTC | — |
| Occurrence of methadone use (urine-toxicology) | Year following release from CDDC or discharge from VTC | This is a proxy for linkage to methadone therapy |
| Occurrence of amphetamine use (urine-toxicology) | Year following release from CDDC or discharge from VTC | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Opioid cravings (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Motivation to change drug use (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Police harassment (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Health-related quality of life (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Days of criminal activity (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Rates of employment (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Total monthly income (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Occurrence of HIV seroconversion (antibody test) | Year following release from CDDC or discharge from VTC | — |
| Social Support (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Detention in CDDC/Incarceration in jail or prison | Year following release from CDDC or discharge from VTC | — |
| Occurrence of drug or methadone use (self-report) | Year following release from CDDC or discharge from VTC | Sub-measures include opioid use, any drug use (opioid, amphetamine, benzodiazepine), methadone use, buprenorphine use |
| Addiction Severity (self-report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Occurrence of non-fatal overdose (self-report) | Year following release from CDDC or discharge from VTC | — |
| Rates of injection-related HIV risk behaviors (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
| Rates of sex-related HIV risk behaviors (self report) | Compared at 3, 6, 9 and 12-months following release from CDDC or discharge from VTC | — |
Outcome results
None listed