Background
Methods
Study design
Study setting and participant recruitment
Data collection
Data analysis
Ethics statement and consent
Results
Variable | Measure | |
No. (%) | ||
Sex | 14 (67.7) | |
Male | 7 (33.3) | |
Female | ||
Mean ± SD | Median (Q1, Q3) | |
Age (years old) | 48.1 ± 6.1 | 46.0 (44.0, 51.0) |
Duration of drug use (years) | 13.9 ± 4.9 | 14.0 (11.0, 18.0) |
Duration of receiving MMT (years) | 12.0 ± 3.7 | 14.0 (10.0, 15.0) |
Mean ± SD | Median (Q1, Q3) | |
Daily methadone dose (mg) | 65.6 ± 52.1 | 47.0 (20.0, 125.0) |
Changes in the number of MMT participants
Many of them died, some of which were still on MMT at that time. Usually, they died of cancer, mostly progressed from hepatitis C, because they had no money to get treated. The majority of us had HCV infection, but few would seek medical help due to the financial hardship.
[P4-male-50 years old] (Note: P4 means the 4th participants interviewed)
There are fewer and fewer people coming here for MMT. I think half died, and half got clean from MMT. Many friends of mine died. Only this year, I have heard that several friends passed away because of illness. They suffer from various kinds of diseases, such as heart attacks, hypertension, and liver or lung cancer due to their long history of drug use. Some of them were very young, just around 40–50 years old.
A lot of people around me have quit since they were totally clean. They have probably been treated for over ten years, since when the clinic opened.
Those who should have come to the MMT clinic had already come. Since heroin is no longer popular, there are no new participants enrolled. I did not know anyone who was still on heroin but had not attended MMT.
[P9-male-46 years old]
I saw fewer and fewer people in the clinic. Some of them get clean, while a few of them may have relapsed. over half of them died of diseases. They injected drugs into veins previously, which were so harmful, and they did not do body examinations either. Some people choose to use other drugs, such as methamphetamines. Being arrested is another reason. I think it’s good for them because compulsory rehabilitation can help them detox.
[P18-male-48 years old]
Improvements in personal life
Physical and mental health status
After attending MMT, my health is much better. Before that, I had to inject drugs every day, and you can see swelling and bruising all over my body. It just looked so scary.
[P4-male-53 years old]
I felt more energetic after being treated. My sleep and appetite are much improved. It surprised me that methadone works so well.
[P1-female-42 years old].
At least, I am more mentally relaxed (after MMT). I don’t act as irritated as before and can think about things more deeply and calmly. Before attending MMT, I would never have been this peaceful, as my whole mind was about drugs, rather than working. I’ve been in the catering industry for 20 years, and I’ve been on heroin for more than half of 20 years. I had to frequently ask for leave during working time due to the strong craving, otherwise, I couldn’t bear it. I felt shameful myself and people would not hire me anymore either.
[P10-female-48 years old]
I feel much better. My assessment of MMT is that I was truly reborn after 2006 (when I attended MMT), my new life started then. Before that, I was muddling through. Only when I received MMT and got off the heroin, did I find my true character.
[P7-male-42 years old]
Family relationships
The relationship with my family has had such a great improvement (after MMT). Before that, family members just isolated me, because so many years of drug use made them completely lose confidence in me. However, they found me not taking heroin anymore after attending MMT, and they started to accept me again. I am now living with my family.
[P6-male-42 years old]
I always asked the family for 100 Yuan a day when I was on heroin, so there must be quarrels and arguments. Now everything is different. They are willing to give me 10 Yuan per day for treatment as it is affordable and they know I am doing the right thing. They once blamed me because I did something wrong. Now I do not ask them for so much money, and I do not have any income, they will support me anyway.
[P9-male-46 years old]
Social functioning
I have a job now, which released my financial burden, so it was quite worth coming to MMT. I’m running my small business, selling handbags, clothes, and so on. I can earn one to two hundred Yuan a day, and that’s enough for a living. I also work as a community volunteer, which is not profitable, but I feel so happy and fulfilled. Living a normal life is so comfortable.
[P5-female-52 years old]
Having methadone here for treatment is legal, at least the police won’t come to arrest me. Therefore, I have no worries, I am free and troubleless. I can walk on the street with my head up.
[P15-male-50 years old]
Challenges encountered during long-term treatment
Treatment-related challenges
Restriction on daily life
We need to take this medicine every day, so we cannot leave this city. I need to take care of my parent at present, but after they pass away, I still want to travel around. However, it is impossible, and the referral is also very troublesome. I seldom go to the countryside, where my hometown is. I just can’t arrange the treatment and travel at the same time.
[P5-female-52 years old]
It’s hard to find a job. I need to come to the clinic at 8 am which makes it impossible to start work at 8 am as required, I can’t make it. It would be better to have a job that has the evening shift, but I have not found one now. The working time must adapt to the opening time of the clinic, as you can’t be late every day, and the boss won’t recruit you.
[P18-male-44 years old]
When I worked in city A, I needed to go to a clinic in city B for treatment, as that was the nearest one. It took me more than one hour by bus and I needed to transfer twice. I finish the evening shift at 8:30 a.m. and can be back home at 11 p.m. I try to look for jobs that are closer to the clinic, that’s the only thing we can do. This problem has a huge impact. Also, when there is typhoon, rain, and so on, it could be more bothering.
[P18-male-44 years old]
The uncertainty of the treatment continuity
I needed to go to the clinic in another district since this area was in lockdown. I used to come here twice a day, and I had to drink all the methadone at one clinic because it was too far away. My main anxiety was that I still needed to pay for rent when my store closed, and how I could ensure the treatment was being quarantined. I called the doctor before the lockdown and was told that I could go to another clinic, which made me feel much better.
[P12-male-49 years old]
The biggest problem is that I can’t get methadone when I am in the hospital. Previously, I can ask the doctor for proof, which allowed my family to get methadone for me. But this is not allowed anymore. The last time I was hospitalized, I still needed to come to the MMT clinic every day, which took me an hour by taxi. This problem must be solved. I don’t even know what will happen if I get sick again in the future. Many people like me, will feel like dying if they can take methadone on time. It’s extremely torture as we’re already in poor health status. It’s essential to have someone to deliver the methadone to us, anyone will do, as long as we can get it. Because we have been treated for so long, we can’t bear the consequence of pausing it for days.
[P7-male-59 years old]
The lack of official guidelines for dose adjustment
I drink about 130 ml currently. It didn’t used to be that much, but I’m slowly adding it because I can’t get sleep and I am taking the antiviral drugs for HIV treatment. These medications are hedged with methadone, that’s why I drink much. Each time I added more I would sleep a little better, otherwise, I couldn’t sleep and would feel depressed. Once I feel better, I will still taper the dose. People I know are also trying to do so. Some of them decreased it to 2 or 3 ml and then quit MMT. They have never come back to the clinic. I want to quit MMT like them as well.
[P12-male- 49 years old]
Personal challenges
Economic hardship
Many of these participants, spent everything out on drugs and are also too old to work. Their family isolated them as well. It is really hard for them to survive. They needed to borrow 10 YUAN a day for MMT, and when they got 10 YUAN, the clinic was already closed. So, they have to help smugglers to sell drugs to get money and heroin, which is not good for society and themselves. But they had no choice.
[P5-female-52 years old]
Social discrimination
If the employers knew I’d used the drug before, they wouldn’t hire me. Even if I’m not on drugs now, they won’t want me anyway. The public all look down on us and discriminate against us.
[P20-male-46 years old]