KUALA LUMPUR: The Health Ministry’s methadone therapy for opioid addiction has proven to be successful.
Introduced 14 years ago, this treatment approach is seen to be the most effective way to reduce the risk of HIV infection among intravenous drug users who share infected needles, according to Health Ministry public health specialist Dr Fazidah Yuswan.
Methadone, a drug used to treat dependency on opioids such as heroin, has been used by several countries such as the United States since the 1960s but Malaysia only started using it in 2005.
Opioids are a class of drugs naturally found in the opium poppy plant. Prescription opioids are used to treat moderate to severe pain but opioids can also make people feel very relaxed and “high”, which is why they can be highly addictive.
Since heroin is usually injected into the vein, it creates additional risks for the user who faces the danger of HIV or other infections.
Methadone’s efficacy in treating opioid addiction has led to a remarkable drop in the number of HIV cases among intravenous drug users.
New HIV infection cases involving this group dropped from 66 percent (of the total number of new HIV cases) in 2005 to 3.4 percent in 2017, Dr Fazidah told Bernama.
She said methadone’s efficacy in reducing HIV infection risk has been proven in the Malaysian Methadone Treatment Outcome Study 2016, which was carried out by Universiti Malaya’s Centre of Excellence for Research in AIDS and the World Bank.
“The infection risk dropped significantly from 6.22 before undergoing methadone treatment to 2.65 after treatment,” she said, adding that the study also found that the therapy helped avert 1,597 cases of HIV infections between 2006 and 2013.
The methadone treatment is expected to prevent some 38,000 cases of HIV infection by 2050, she added.
Dr Fazidah said as the prime mover of the methadone therapy, the Health Ministry has made the treatment available at 403 government clinics and 55 hospitals nationwide.
“Currently, 45 per cent of government clinics are offering the treatment. The ministry is targeting to increase the percentage to 65 percent or 900 clinics nationwide by 2030,” she said.
The methadone treatment is also available at rehabilitation centres run by the National Anti-Drugs Agency at 24 locations, as well as at 22 prisons.
Between 2005 and June 2018, a total of 47,556 people had registered at government facilities to obtain methadone treatment. Out of that number, 18,000 patients are still undergoing the treatment, said Dr Fazidah.
About 52,000 people, meanwhile, had registered at private clinics to obtain methadone treatment, out of which 35,000 are still undergoing treatment.
Between 2005 and 2018, about 99,556 people had sought methadone treatment at government and private clinics, she added.
According to Dr Fazidah, the Health Ministry spends about RM1.5 million a year on the procurement of methadone.
“The cost of treating each patient over a one-year period comes to about RM450. An average 80mg dose of the drug costs RM200 (per patient per year) with the balance amount going towards lab tests to monitor the patient’s treatment,” she said, adding that the government facilities offer the methadone treatment to the public at no cost.
She also said that the cost factor was one of the reasons methadone was used to treat and rehabilitate opioid drug users.
Furthermore, she added, it was also found to be the most effective medication to help opioid addicts overcome their dependency and has few side-effects too.
Methadone is administered every day under a doctor’s supervision, but the more stable patients who are working or have to go outstation are allowed to take home a three-day supply of methadone.
“We want to make it easier for the patients as many of them have changed and are leading normal lives after undergoing methadone treatment,” Dr Fazidah said.
However, she added, they needed continuous treatment because when it came to the rehabilitation of drug addicts, the term ‘already cured’ or ‘completely recovered’ did not exist.
Similar to people who suffer from chronic diseases like hypertension and diabetes, ex-opioid dependents also have to be on methadone medication over the long term.
There are people who are completely off methadone and leading normal lives but they were few in number, she pointed out.
On the possibility that the patients could develop a dependency on methadone, she said: “No study ever done has shown that methadone can cause addiction. Just because a diabetic patient takes medication to treat his diabetes on a daily basis, it doesn’t mean that he is addicted to the drug.”
Methadone was only suitable for those addicted to opioids, said Dr Fazidah, adding that no treatment has been found for addiction to synthetic drugs like ecstasy and syabu.