Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2020

01-12-2020 | Opioids | Research

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

Authors: Andrew Scheibe, Shaun Shelly, Tara Gerardy, Zara von Homeyer, Andrea Schneider, Kalvanya Padayachee, Shalon Balaguru Naidoo, Klaas Mtshweni, Ayanda Matau, Harry Hausler, Monique Marks

Published in: Addiction Science & Clinical Practice | Issue 1/2020

Login to get access

Abstract

Background

Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa.

Methods

We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization’s Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar’s test was used for comparisons between paired results of categorical variables relating to injecting frequency.

Results

The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254).

Conclusions

Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.
Footnotes
1
Between January and June 2018, 260 people who inject drugs were on OST across five major cities through non-government and not-for-profit services.
 
2
ASSIST provides a score (overall and disaggregated by substance) reflecting the level of risk (low, moderate and high).
 
Literature
1.
2.
3.
UNODC. World Drug Report Executive summary. Conclusions and Policy Implications. Vienna: United Nations Office on Drugs and Crime; 2018.
4.
5.
UNAIDS. Health, rights and drugs. Harm reduction, decriminalization and zero discrimination for people who use drugs. 2019.
6.
Stahl S. Stahl’s essential pscyhopharmacology. Cambridge: Cambridge University Press; 2013.
7.
8.
Valentine K, Fraser S. Trauma damage and pleasure: Rethinking problematic drug use. Int J Drug Policy. 2008;19:410–6.CrossRefPubMed
9.
10.
11.
WHO. Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: World Health Organization; 2009.
12.
13.
World Health Organization, United Nations Office on Drugs and Crime, Joint United Nations Programme on HIV/AIDS. Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention. Position paper. 2004; 1–33.
14.
Caplehorn JR, Dalton MS, Haldar F, Petrenas AM, Nisbet JG. Methadone maintenance and addicts’ risk of fatal heroin overdose. Subst Use Misuse. 1996;31:177–96.CrossRefPubMed
15.
16.
Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess. 2007;11:1–171.PubMed
17.
18.
Christie TKS, Murugesan A, Manzer D, Shaughnessey MVO, Webster D. Evaluation of a low-threshold / high-tolerance methadone maintenance treatment clinic in saint john, new Brunswick, Canada: 1 year retention rate and illicit drug use. J Addict. 2013;13:1–5. https://​doi.​org/​10.​1155/​2013/​753409.CrossRef
19.
20.
21.
Gourlay J, Ricciardelli L, Ridge D. Users’ experiences of heroin and methadone treatment. Subst Use Misuse. 2005;40:1875–82.CrossRefPubMed
22.
Scheibe A, Marks M, Shelly S, Gerardy T, Domingo A, Hugo J. Developing an advocacy agenda for increasing access to opioid substitution therapy as part of comprehensive services for people who use drugs in South Africa. S Afr Med J. 2018;108:800–2.CrossRefPubMed
23.
United Nations Office on Drugs and Crime. World Drug Report 2015. Vienna: United Nations Office on Drugs and Crime; 2015.CrossRef
24.
United Nations Office on Drugs and Crime. UNODC 2018 Prevalence of drug use in the general population–national data. Vienna: United Nations Office on Drugs and Crime; 2018.
25.
Statistics South Africa. Mid-year population estimates 2018. Statistical release P0302. Pretoria: Statistics South Africa; 2018.
26.
Dada S, Harker Burnhams N, Erasmus J, Parry C, Bhana A, Kitshoff D, et al. Monitoring alcohol, tobacco and other drug use trends in South Africa. Res Brief. 2017;20:1–9.
27.
Howell S, Harker-Burnhams N, Townsend L, Shaw M. The wrong type of decline: fluctuations in price and value of illegal substances in Cape Town. SA Crime Q. 2015;54(1):43–544.CrossRef
28.
Weich L. Defeating the dragon–can we afford not to treat patients with heroin dependence? S Afr J Psychiatry. 2010;16:75–9.
29.
Michie G, Hoosain S, Macharia M, Weich L. Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa. S Afr Med J. 2017;107:539–42.CrossRefPubMed
30.
World Health Organization. Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. Geneva: World Health Organization; 2016.
31.
Scheibe A, Shelly S, Versfeld A, Howell S, Marks M. Safe treatment and treatment of safety: call for a harm-reduction approach to drug-use disorders in South Africa. S Afr Health Rev. 2017;20:197–204.
32.
33.
Scheibe A, Matima R, Schneider A, Basson R, Ngcebetsha S, Padayachee K, et al. Still left behind: harm reduction coverage and HIV treatment cascades for people who inject drugs in South Africa. In: 10th IAS Conference on HIV Science. Mexico; 2019.
34.
South African National Department of Health. Standard treatment guidelines and essential medicines list for South Africa. Hospital level. 3rd ed. Pretoria: Department of Health; 2012.
35.
36.
37.
National Department of Health. Standard treatment guidelines and essential medicines list for South Africa: primary healthcare level. 2018th ed. Pretoria: South African National Department of Health; 2018.
38.
Harm Reduction International. The Global state of harm reduction 2018. 6th ed. London: Harm Reduction International; 2018.
39.
World Health Organization. The alcohol smoking and substance involvement screening test. Geneva: World Health Organization; 2010.
40.
Weich L, Nowbath H, Flegar S, Mahomedy Z, Ramjee H, Hitzeroth V, et al. South African guidelines for the management of opioid dependence. Updated 2013. 2013.
41.
Weich L, Perkel C, van Zyl N, Rataemane P, Naidoo L, Nowbath H, et al. South African guidelines for the management of opioid dependence. S Afr Addict Med Soc. 2013;100:1–18.
42.
Quality Metric Incorporated. User’s manual for the SF-12v2 Health survey. 3rd ed. Quality Metric Incorporated: Lincoln; 2012.
43.
Veilleux JC, Colvin PJ, Anderson J, York C, Heinz AJ. A review of opioid dependence treatment: pharmacological and psychosocial interventions to treat opioid addiction. Clin Psychol Rev. 2010;30:155–66.CrossRefPubMed
44.
45.
46.
47.
48.
49.
Akindipe T, Abiodun L, Adebajo S, Lawal R, Rataemane S. From addiction to infection: managing drug abuse in the context of HIV/AIDS in Africa. Afr J Reprod Health. 2014;18(3):47–544.PubMed
50.
51.
52.
Walley AY, Cheng DM, Pierce CE, Chen C, Filippell T, Samet JH, et al. Methadone dose, take home status, and hospital admission among methadone maintenance patients. J Addict Med. 2012;6:186–90.CrossRefPubMedPubMedCentral
53.
54.
Villafranca SW, McKellar JD, Trafton JA, Humphreys K. Predictors of retention in methadone programs: a signal detection analysis. Drug Alcohol Depend. 2006;83:218–24.CrossRefPubMed
55.
56.
Smolka M, Schmidt LG. The influence of heroin dose and route of administration on the severity of the opiate withdrawal syndrome. Addiction. 1999;94:1191–8.CrossRefPubMed
57.
58.
59.
60.
Amato L, Davoli M, Minozzi S, Ferroni E, Ali R, Ferri M. Methadone at tapered doses for the management of opioid withdrawal. Cochrane database Syst Rev. 2013;2:CD003409.
61.
Lingford-Hughes AR, Welch S, Peters L, Nutt DJ, et al. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol. 2012;26:899–952.CrossRefPubMed
62.
Van Den Brink WW, Haasen C. Evidenced-based treatment of opioid-dependent patients. Can J Psychiatry-Revue Can Psychiatr. 2006;51:635–46.CrossRef
63.
64.
Mattick RP, Breen C, Kimber J, Davoli M, Richard PM, Breen C, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2:CD002207.
65.
66.
67.
Epstein DH, Preston KL. Does cannabis use predict poor outcome for heroin-dependent patients on maintenance treatment? Past findings and more evidence against. [comment] [erratum appears in Addiction. 2003 Apr 98(4):538]. Addiction. 2003;98:269–79.CrossRefPubMedPubMedCentral
68.
Socías ME, Wood E, Lake S, Nolan S, Fairbairn N, Hayashi K, et al. High-intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis. Addiction. 2018;113:2250–8.CrossRefPubMedPubMedCentral
69.
Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010;376:1558–65.CrossRefPubMed
70.
The Constitutional Court of South Africa. Minister of justice and constitutional development and others v prince (Clarke, Stobbs and Thorpe Intervening) (Doctors of Life International Inc as Amicus Curiae); National Director of Public Prosecutions and Others v Rubin; National Director of Public P. 2018. https://​hdl.​handle.​net/​20.​500.​12144/​34547.
71.
Dada S, Harker N, Jodilee B, Warren E, Parry C, Bhana A, et al. April 2019 Phase 44. Cape Town: SA Medical Research Council; 2019.
72.
UNODC, UNWOMEN, WHO, INPUD. Women who inject drugs and HIV: addressing specific needs issue summary: the key reasons and unique challenges. Policy brief. 2014.
73.
Dannatt L, Cloete KJ, Kidd M, Weich L. Frequency and correlates of comorbid psychiatric illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit, South Africa. S Afr J Psychiatry. 2014;20:77.CrossRef
74.
Metadata
Title
Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa
Authors
Andrew Scheibe
Shaun Shelly
Tara Gerardy
Zara von Homeyer
Andrea Schneider
Kalvanya Padayachee
Shalon Balaguru Naidoo
Klaas Mtshweni
Ayanda Matau
Harry Hausler
Monique Marks
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2020
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-020-00186-7

Other articles of this Issue 1/2020

Addiction Science & Clinical Practice 1/2020 Go to the issue

Review

Smartphone apps for managing alcohol consumption: a literature review

Case Study

Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach

Research

Chinese- and English-speaking adult current smokers’ perspectives on smoking and culturally and linguistically appropriate cessation: a qualitative analysis

Research

Integrated stepped alcohol treatment for patients with HIV and at-risk alcohol use: a randomized trial

Study Protocol

Design of a randomized controlled trial to Link Infectious and Narcology Care (LINC-II) in St. Petersburg, Russia

Editorial

Introduction to the special issue