Rétention en traitement et évolution de la clientèle d’un programme montréalais de substitution à la méthadone à exigences peu élevées

Abstract

Objectives: To evaluate client treatment retention and evolution in terms of living conditions, atrisk behaviours, and the use of psychoactive substances (PAS) over a one-year period, following admission into a low-threshold methadone program in Montreal. Method: Individual interviews were administered to 114 clients from Relais-Méthadone (RM) at admission and one year after treatment initiation. Participants reported on PAS consumption and unsafe practices of drug use and sexual behaviours at high risk for transmission of HIV, sexually transmitted infections (STI) and other blood-borne viruses (BBV). Services utilized by clients were documented from Relais-Méthadone files. Bivariate analyses were used to compare data recorded at admission and one-year follow-up. Results: The treatment retention rate after one year at RM was 64%. However, by taking into account those clients who were transferred to a regular program during the study period, as well as those who voluntarily tapered their methadone treatment (16.7%), the status of 80.7% of clients demonstrated improvement one year after admission into treatment. Furthermore, the clients who remained in treatment for a year for whom information was available (n=60) showed a tendency towards more stable living conditions. They also demonstrated a significant decrease in both the number of PAS injections and in risky behaviours related to drug consumption. A statistically significant decrease in the frequency of heroine and cocaine use was also observed. By contrast, however, two thirds of the individuals in treatment after a year (n=42) maintained or increased their daily consumption of other PAS. Discussion: The treatment retention rate is comparable to other low or regular threshold substitution programs. The results support previous studies showing that the methadone substitution treatment reduces heroine and cocaine consumption, and decreases the number of unsafe behaviours that could potentially transmit HIV, STI and BBV for the majority of clients who remained in treatment. Future research could focus attention on people who abandon treatment and those who present at-risk behaviours during treatment.

Initiation of Low-threshold Buprenorphine in Nontreatment Seeking Patients With Opioid Use Disorder Engaged in Hepatitis C Treatment

“…As such, expanding access to buprenorphine for PWID within this framework may allow for more successful engagement of PWID in treatment of OUD. Methadone maintenance programs first applied the harm reduction framework to OAT delivery by providing OAT regardless of ongoing opiate use, and demonstrated retention rates similar to regular threshold programs with significant reductions in mortality and HIV risk 20–22 . In New York City and Philadelphia, buprenorphine programs integrated into harm reduction organizations engaged individuals accessing other services and demonstrated retention comparable to traditional outpatient medical settings 23,24 .…”

“…Methadone maintenance programs first applied the harm reduction framework to OAT delivery by providing OAT regardless of ongoing opiate use, and demonstrated retention rates similar to regular threshold programs with significant reductions in mortality and HIV risk. [20][21][22] In New York City and Philadelphia, buprenorphine programs integrated into harm reduction organizations engaged individuals accessing other services and demonstrated retention comparable to traditional outpatient medical settings. 23,24 In recent years, low-threshold buprenorphine programs aimed to engage marginalized populations of PWID, including criminal system-involved and homeless individuals, have also been developed.…”