Perceived Barriers to Post-release Participation in Methadone Maintenance Treatment: Perspectives of Compulsory Drug Detoxification Center Detainees in Yunnan, China

Background: The Chinese Methadone Maintenance Treatment (MMT) Program was established in 2004 and has expanded rapidly to 28 provinces, autonomous regions, and municipalities with a total of 738 MMT clinics providing treatment for a cumulative total of more than 344,000 patients at the end of 2011. However, the total number of patients being treated daily accounted for less than 20% of all registered opiate users not counting the unregistered drug-using population. Coverage of the community-based MMT program is still low and the dropout rate among MMT patients remains high. The primary objective of this study is to identify barriers associated with detainees' unwillingness to participate in community-based MMT when released from compulsory drug detoxification centers in China. Methods: This study was carried out in two compulsory drug detoxification centers in Mangshi City, Dehong Prefecture, Yunnan Province. Between July and November, 2012, in-depth interviews were conducted with 20 incarcerated drug users in one center. A total of 250 incarcerated drug users was also recruited to participate in a face-to-face cross-sectional survey using a convenient sampling method in the other center.Results: The majority of our study participants expressed their unwillingness to initiate MMT enrollment post-release, which is of great concern. Most participants' reasons for unwillingness to take part were: no perceived needs to participate in MMT; misconceptions and lack of MMT-related knowledge; limited accessibility and financial difficulties. Moreover, side-effects, inconvenience, dosage and concurrent opiate and stimulant uses were indicated as reasons for dropping out. We also documented that ethnic disparities existed in this culturally and geographically diverse population. Lastly, a surprisingly high proportion of our study participants reported using stimulants, specifically ephedrine, as their primary drug of choice.Conclusions: There is an urgent need to revamp the current practices inside the compulsory drug detoxification and rehabilitation centers as well as the community-based MMT programs in China. A comprehensive Pre-release Relapse Prevention Program needs to be established to prepare those soon-to-be released detainees for life after incarceration. The community-based MMT program needs to be expanded to include psychological counseling and behavioral modification in order to retain patients and prevent high dropouts. In addition, testing for non-opiate drugs as part of the urine-monitoring program at MMT clinics needs to be implemented. Ethnic disparities need to be considered when designing future educational campaigns and prevention programs. And educational materials regarding the danger of stimulants addiction should be developed and disseminated among drug users and the general public as soon as possible. Further training on drug addiction as a chronic disease and methadone related knowledge should be provided for compulsory drug detoxification and rehabilitation center staff. Cooperation between public security and health sectors also needs to be strengthened