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2016/6/25 Methadone Maintenance Therapy in Taiwan Dr. Happy Kuy-Lok Tan, M.D., MPH.,MHS 17 October 2008.

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Presentation on theme: "2016/6/25 Methadone Maintenance Therapy in Taiwan Dr. Happy Kuy-Lok Tan, M.D., MPH.,MHS 17 October 2008."— Presentation transcript:

1 2016/6/25 Methadone Maintenance Therapy in Taiwan Dr. Happy Kuy-Lok Tan, M.D., MPH.,MHS 17 October 2008

2 Taiwan : 36,000 km2  Area: 36,000 km2  (2007) Population: 22,958,360 Per Capita GNP:US$15,676 (2008 ) Life Expectancy at birth male: 75.6 female:82.3

3 A global view of HIV infection 33 million people [30–36 million] living with HIV, 2007 2.2

4 HIV/AIDS prevalence (%) among injecting drug users (1998- 2003)

5 Spreading of HIV in IDU

6 Methadone Maintenance Therapy (MMT) Developed by Dr. Vincent Dole and Dr. Marie Nyswander in 1965 Controlled, supervised supply of narcotics in a medical sense 2 useful effects: –relief of narcotic hunger –Induction of sufficient tolerance to block the euphoric effect Effective to treat Heroin dependence

7 Initiated by Center of Disease, Taiwan Preparation (2004~2005) Refer to other countries’ experiences, e.g. Australia, Hong Kong Invited foreign experts to share experiences International conferences MMT Program in Taiwan

8 Visit Hong Kong November 1, 2005 10 staffs visit Hong Kong Methadone clinic

9 Australia Rankin Court Methadone Maintenance clinic

10 Invite Foreign Experts Dr. Alex Wodak

11 Taiwan Dr. Alex Wodak

12 MMT Program Pilot project in 2005 by Pilot project in 2005 by  Implemented at Taipei City (1 hospital) Taipei City (1 hospital) Taipei County (1 hospital) Taipei County (1 hospital) Taoyuan County (3 hospitals) Taoyuan County (3 hospitals) Tainan County (1 hospital) Tainan County (1 hospital)

13 13 The first Methadone clinic at Tao-Yuan Mental Hospital Methadone clinic

14 14 Drug abuse Treatment Team of TMH Set up drug abuse treatment team Devoted in drug treatment and research行政院衛生署桃園療養院 Aug, 2005Oct, 2008 Psychiatrists25 Psychiatric Nurses 18 Social workers13 Psychologist11

15 Drug abuse treatment Team

16 Treatment model of the MMT program in TMH Methadone replacement –Harm-reduction oriented –Low threshold Drug counseling, education Case Management Supportive psychotherapy Crisis intervention Job counseling 2016/6/25

17 Out patient service OPD:Mon, Fri AM; Mon~Thu PM Taoyuan Mental Hospital, Department Of Health Since 10 Feb 2006 Nurse Evaluation Social Worker Physician Interview CBC, BCS, EKG, CxR

18 Computer Software Developed by our psychiatrist, Dr. Chou 2 major parts: –Computer assisted drug dispensing Correct person, Correct dose Identification and verification Record attendance and dose Make reports automatically –Computer assisted case management Monitor the attendance rate

19 Computer-aided drug administration

20 Real-time statistics

21 Cases overview

22 Individual treatment history

23 Fingerprint Iris Recognition 2006/2/10~2007/11/30 2007/12/1~ Confirm identity

24 Dispensing of methadone Taoyuan Mental Hospital, Department Of Health Time of operation: 7:15am – 9pm

25 4 case managers (psychiatric nurses) Out patient counseling Phone call to :absentees for three days Remind OPD follow up Phone call 50,511 (Feb 10,2006-July 31, 2008) Case management

26 Case Number in Taoyuan Mental Hospital MMT program

27 HIV prevalence (N=2854) 2016/6/25

28 HCV prevalence (N=2854) 2016/6/25

29 Daily attendance rate in the MMT program of TMH Max: 96.3% Min: 67.8% Average: 85.2%

30 Retention Rate days

31 Urine Test for morphine and amphetamine week

32 Opiate Treatment Index Multi-dimensional analysis of MMT effectiveness –Drug use behavior –Needle use and sexual behaviors –Social functions –Health condition –Psychological adaptation Reliability and validity tests

33 OTI Employment rate (N=110)

34 OTI Monthly Income and Heroin Expense (N=110) Average income of general population : NT 44,240

35 OTI Daily Heroin Use Frequency (N=110)

36 OTI subscales (N=110) Lower score better outcome

37 Education at Prisons :MMT –32 sessions ， 1,770 prisoners Schools : Say No to Drugs –38 sessions ， 14,093 students and teachers 。 Education in schools and jails (Sep 2005-Dec.2007)

38 Education on MMT July 2006-July 2008 8 hours essential training for MMT: 8 sessions 1,162 Psychiatric Workers and Public Health workers, staff of correctional facilities Site Visit from 22 hospitals

39 Newspaper : 26 articlesNewspaper : 26 articles Electric media: 3Electric media: 3 Magazines: 1Magazines: 1 Educational film:Educational film: 2006---2 (CDC) 2007---1(CDC) Educational brochure Public Education : media

40 Prime Minister visited TMH and talked with an IDU media

41 行政院衛生署桃園療養院 Taoyuan Mental Hospital, Department Of Health Acknowledgement from the government

42 Winning awards

43 MMT Program Pilot projects in 2005 Pilot projects in 2005 Island-wide after 2006.07 Island-wide after 2006.07 2008.08 2008.08 23 counties 23 counties 68 sites 68 sites

44 MMT in Taiwan: Numbers of hospitals & clinics

45 MMT in Taiwan Case Number 2007.01-2008.1.9. Cumulative treatment cases On treatment cases

46 Gender ratio (Dec 31, 2007)

47 Age Distribution

48 1813 2462 629 71 3 年 Annual Numbers of Newly Reported HIV Cases by Mode of Transmission (CDC, Taiwan 2008) MMT

49 Methadone Maintenance Therapy Worldwide (57 countries) AustraliaCanadaFrance AustriaChinaGermany AlbaniaCroatiaGreece Andorra CzechHungary BelgiumDenmarkHong Kong Bulgaria EcuadorIceland BahrainEnglandIndonesia BermudaEstoniaIran BoliviaFijiIsrael Bosnia and Herzegovina FinlandIreland

50 Methadone Maintenance Therapy Worldwide ItalyNamibiaSouth Africa LiechtensteinNepalSri Lanka LuxemburgNorwaySpain Lithuania PolandThailand Macedonia PortugalTaiwan MalaysiaScotland United Kingdom Malta SloveniaUnited states MexicoSweden NetherlandsSwitzerland New ZealandSlovak Republic

51 MMT Program in Taiwan Awareness and Preparation2004.01 Awareness and Preparation  Refer to other countries’ experiences, eg. Australia, New York(U.S.), Hong Kong Action plan2005.01. Action plan Start “MMT pilot projects2005.11 Start “MMT pilot projects” in 1 city and 3 counties 2006.02. The first MMT case enrolled in Taoyuan Mental Hospital Expansion nationwide2006.07 Expansion nationwide

52 TaiwanTaoyuan 2008VS.2007↓33%↓40% 2007VS.2006↓34%↓46% 2006VS.2005↓14%↓36%

53 Criminal rate TaiwanTaoyuan 2007 VS 20064% 19.7% 2006 VS 2005 8% 13% Criminal rate = cases/100,000 population

54 MMT in Taoyuan 2006.062006.122007.062007.122008.06 Taoyuan Mental Hospital (2006.02 begin) 135(100%)256(57%)775(76%)1182(75%)1121(65%) Hsin Kuo Min General Hospital (2007.07 begin) 25(1.6%)223(13%) Taoyuan Armed Forces General (2006.06 begin) 112(25%)141(14%)163(10.4%)195(11%) Taoyuan Veterans Hospital (2006.07 begin) 84(18%)105(10%)172(11%)195(11%) Total 135452102115691734

55 Conclusion MMT is an effective treatment for heroin abusers in Taiwan Rapid expansion of MMT in Taiwan helped to control the spread of HIV infection This successful experience can be shared to other country with similar problem

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