Treatment a lifeline for heroin addicts
By Wu Jiachun, Qin Jize & Liu Weifeng (China Daily)
Updated: 2004-06-26 01:20

When he decided to put his past as a drug addict behind him, Zhao started an MMT course in a clinic in Gejiu, Southwest China's Yunnan Province.

Every day, hundreds of addicts take the prescribed drug methadone -- a synthetic opiate -- which is used at the clinic as a maintenance treatment for heroin addiction.

Feeling reborn after his painstaking struggle, Zhao, in his 30s, now works as a volunteer counsellor at the clinic to help others recover a meaningful life.

It is said that once a methadone patient has successfully shaken heroin, their appearance and lifestyle can return to normal.

Zhao is one of the success stories and he is assisted by two other counsellors at the clinic.

Yunnan is the gateway to China for drugs from the notorious Golden Triangle.

Passers-by watch pictures about the harm of drug addiction at an exhibition at the railway station in Lanzhou, capital city of Northwest China's Gansu Province on Thursday. Local police organized the event to mark the Global Anti-Drug Day which falls Saturday. [newsphoto]

Statistics show that HIV/AIDS is a big challenge in China now and Yunnan has 14,905 HIV carriers -- the most in the country.

In March, the province implemented its anti-AIDS regulation. One of the strategies was to introduce and expand the MMT in communities.

In mid-April, the first provincial MMT clinic was set up in the city of Gejiu in Yunnan.

As early as last February, a working plan to introduce the MMT was jointly issued by the Ministry of Health, the Ministry of Public Security and the State Food and Drug Administration.

A total of eight national MMT clinics are now operating in five provinces and autonomous regions -- Yunnan, Sichuan, Zhejiang and Guizhou provinces and the Guangxi Zhuang Autonomous Region.

The MMT programme is providing addicts with an additional option for getting off the needle and sharing needles, which has caused an explosion in the number of HIV cases. Methadone is taken orally.

Min Xiangdong, director of the Gejiu Centre for Disease Control and Prevention, said the clinic's doctors diagnose patients and then prescribe them the necessary dosages of the methadone.

The patients take the methadone under the supervision of the doctor and stay for another 25 minutes for observation.

The production, transportation and safekeeping of the methadone is strictly controlled.

An increasing number of addicts are accepting the MMT programme as it is the most cost-effective treatment available for heroine users.

Initially, the methadone costs only 5 yuan (US$0.6) per treatment, but the price is set to double. The affect of methadone lasts for about 24 hours.

"The government subsidy will help the clinic make ends meet," Min added.

More than 80 people enrolled at the Gejiu clinic in the first month of its operation.

Since then, the number of patients has increased quickly. The clinic has a capacity of 250 to 300.

However, as methadone is an addictive narcotic drug under State control, the procedures to apply for an MMT course is strict.

Min said not all applicants are successful in becoming part of the programme.

A successful applicant must be an intravenous user, more than 20 years old, had at least two periods of abstinence from drugs, have a local address and a civil capacity.

Those who only meet the last two conditions but are HIV carriers are also eligible.

Most of Gejiu's residents are in favour of the methadone treatment as it offers another way to prevent the spread of AIDS among heroin-dependent patients, according to a survey conducted by the disease control and prevention centre, which was conducted before the clinic was set up.

That is despite objections to the MMT on the grounds that it merely replaces one drug dependency for another.

The benefits of MMT

The MMT programme, which retains all those who enroll in treatment, said Min, substantially reduces their illicit drug use and involvement in criminal activities, in addition to improving their health and well-being.

Although not under the national programme, Kunming, capital of the southern province of Yunnan, is also using the MMT method

According to Liu, a former patient and now a staff member at the Yunnan Institute for Drug Abuse, about 1,500 people have come in for consultations since April.

Among them, 15 people have checked into the inpatient department.

Although the experimental MMT programme is so far a success, it is still facing great challenges, say experts.

Li Jianhua, deputy director of the Yunnan institute,says that methadone treatment has long been hampered by government regulations, which require patients to get approval from their hospital, community and public security office.

The requirements work against patients' efforts to keep their recovery confidential, so as not to disturb their employment and study.

It means many turn their backs on the opportunity to access the treatment.

The migrant population is excluded from the treatment because of a lack of a local address.

However, members of the group are at a high risk of contracting AIDS. It would also be too expensive for many of them.

"We can't provide the treatment for free right now," Li said.

Heroin is one of the hardest addictive drugs to kick and chronic users can experience intense cravings for years.

Methadone is also an opiate but it blocks the "high" that heroin offers, allowing for motivation to stop using heroin.

Essentially, the patient remains physically dependent on an opiate, but is freed from the compulsive, uncontrolled and disruptive use seen in heroin use.

"Methadone is a useful way to curb more AIDS/HIV cases, which has been proved for decades throughout the world, though some countries are still conservative on this point," said Ray Yip, director of the Global AIDS Programme-China, in a interview with China Daily.

He suggested all the drug users to adopt the methadone therapy, better control the users addict and daily expanse, and less threat to his/her family and the whole society as well.

He said Hong Kong set a good example in methadone using in recent years, who introduced the therapy in 1970s.

Drug users take in a certain dose of methadone in the morning before he goes out for work, which can sustain his normal work for a whole day, at the cost only about 10 yuan (US$1.2).

In fact, community MMT programmes have expanded rapidly throughout the globe in recent years.

There is ample data supporting their effectiveness in reducing high-risk injecting behaviour and in diminishing the risks of contracting HIV.

A recent study in Sweden found that the drug dependency of 80 per cent of methadone patients dramatically decreased, allowing them to get their lives back on track and stay out of trouble with the law.

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