Viet Nam News spoke to UNAIDS country director Eamonn Murphy about Viet Nam's efforts to treat drug users with methadone detoxification measures.
How does drug abuse in Viet Nam stack up against the problem worldwide?
The Government of Viet Nam estimates that there are 150,000 drug users in Viet Nam. This represents approximately 0.5 per cent of the population of males aged 15 to 45, which is toward the mid-range of countries with opiate injection epidemics. Approximately 80 per cent of drug users in Viet Nam are thought to be heroin injectors.
An estimated 90 per cent of addicts relapse into addiction after being released from administrative detention centres in Viet Nam. Is methadone treatment more effective than other detoxification methods in preventing drug users from relapsing?
Methadone maintenance therapy is the single most effective treatment for heroin dependence in the world. More than any other treatment, methadone keeps people in treatment therapies and reduces HIV transmission, criminal behaviour, drug-related morbidity and overdose deaths.
However, it is important to understand that methadone is not a detoxification approach. Detoxification, which technically applies to the brief period of a week or so after the cessation of drug use, is a necessary first step in the treatment process, but detoxification alone is not drug dependence treatment. Drug dependence treatment with medication such as methadone works by eliminating withdrawal symptoms, reducing or eliminating cravings, and blocking the euphoric effects of drug use.
Drug dependence treatment with methadone is significantly more effective than prolonged detention for drug users. In no country in the world has prolonged detention been found to result in high long-term abstinence rates after release. Rather, high drug use relapse and drug overdose death rates are common among detainees post release.
Methadone allows patients to be treated in their communities, live with their families and contribute to the workforce. Treatment in the community also means that patients can fully access HIV prevention and care services, while general healthcare for conditions like TB and mental illness may not be widely available while in detention.
Methadone is also substantially cheaper than other approaches. It costs less than US$1 per day to treat a patient with methadone in Viet Nam, and the methadone programme in Viet Nam saves between $4-7 for every dollar spent via reducing drug-related crime and related criminal justice and imprisonment costs.
What is the role of families and social organisations in this treatment?
Methadone helps patients make significant progress in their physical and emotional lives, as well as in their relationships with others and their ability to contribute meaningfully to their communities. However, there is also a clear and very necessary role for family and social organisations to support an individual on the road to recovery. The intent is for patients on methadone to lead ‘normal lives', but the reality is that for the first months and throughout the patient's treatment, family and psychosocial services are often needed to provide support, guidance and practical assistance to facilitate the restoration of a healthy lifestyle.
After success in piloting methadone for more than 1,700 drug users in Hai Phong and HCM City, Viet Nam this year has applied this treatment method in seven cities and provinces and is prepared to spread this method nationwide with the target of about 80,000 drug users accessing methadone treatment by 2015. What steps should the country take to reach the target?
Our best estimates for the requirement for methadone coverage vary between 40 and 80 per cent of the heroin-dependent population. As the Government has estimated that 80 per cent of the 150,000 drug users are heroin injectors, the Ministry of Health target of 80,000 people on methadone is around the middle of the recommended target range and is a good target for the next phase.
The efforts required to reach this target will be substantial but not impossible, and, with Government and multiple donor support already guaranteed, is likely to be successful. This target will be most easily reached when clear guidance is provided for methadone implementation, and training programmes and effective monitoring and mentoring systems are established. Effective decentralisation of responsibility to local level institutions will also be needed to allow best practice models to flourish.
What technical and financial assistance will the UN and other international organisations give Viet Nam in spreading this new treatment model?
There are a number of international agencies which are already committed to providing financial and technical support to the development of the methadone programme in Viet Nam, including the US President's Emergency Plan for AIDS Relief; the World Bank, in collaboration with the UK Department of International Development; and the Global Fund for AIDS, Tuberculosis and Malaria. The UN is providing technical assistance to these programmes and is also actively providing advocacy for the embedding and expansion of this treatment modality. — VNS