Increased methadone dose reduces illicit drug injection among HIV negative methadone clients in Myanmar

Background: HIV prevalence rate among People who inject drugs (PWID) in Myanmar is high at 28.5%. The transmission of HIV can be reduced by reducing unsafe needle sharing among injecting drug uses and Opioid substitution. National Drug Abuse Prevention and Control Programme in Myanmar has increased financial and programmatic support for Methadone Maintenance Therapy as an Opioid Substitution Therapy (OST), paralleling with Needle Syringes Exchange Programme (NSEP). Out of 83,000 estimated people who inject drugs, more than 12,550(15%) had taken methadone for Opioid substitution in 2017. Evaluation of methadone programme is vital for the efficient service delivery.
Methods: A cross-sectional study was conducted in five cities with stratified random sampling from all State/ Regions of Myanmar, where methadone services delivered. A sample of 42 persons from each site with minimum 6-month duration on methadone, total 210 respondents were recruited to answer survey questionnaires relating to methadone profile, drug use history for 30 days and urine sample collection for methadone and illicit drug use detection (Morphine, Cannabis, Methamphetamine, Amphetamine, Benzodiazepam).
Results: Findings showed that 93 (44.5%) didn''t inject within 30 days and 116 (55.5%) admitted that they injected heroin. Those respondents had average methadone dose of 83 mg ranging from 20 to 300mg and reported HIV is 74 out of 200, 37% of who answered. An increase in methadone dose proved that reduced in the reported drug injection within 30 days especially among HIV negative respondents (P= 0.00) in Cox regress analysis. This finding is also consistent with less use of Morphine in the urine samples (P=0.034) and less use of Cannabis in the urine findings (P=0.032). However, there is association of methadone dose and Benzodiazepam in the urine (P=0.014).
Conclusions: High dose of methadone maintenance therapy more than 80mg is crucial in reducing of illicit drug injection among HIV negative individuals which can subsequently reduce the unsafe practice of sharing needle among injecting drug uses. The increased methadone dose can further prevent HIV transmission among people who inject drugs. This methadone evaluation finding from Myanmar will be useful for other similar settings where methadone is used for Opioid substitution worldwide.

S. Tun1,2, V. Balasingam Kasinather2, D. Singh Mahinder Singh2
1Myanmar Medical Association, Yangon, Myanmar, 2University Sains Malaysia, University of Science, Centre for Drug Research, Penang, Malaysia