Methadone Maintenance Therapy in Taiwan Dr Happy KuyLok

Methadone Maintenance Therapy in Taiwan Dr. Happy Kuy-Lok Tan, M. D. , MPH. , MHS 17 October 2008 2021/6/7

Taiwan § Area: 36, 000 km 2 § (2007) Population: 22, 958, 360 Per Capita GNP: US$15, 676 • (2008 ) Life Expectancy at birth male: 75. 6 female: 82. 3

A global view of HIV infection 33 million people [30– 36 million] living with HIV, 2007 2. 2

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

Spreading of HIV in IDU

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

MMT Program in Taiwan 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

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

Australia Rankin Court Methadone Maintenance clinic

Invite Foreign Experts Dr. Alex Wodak

Taiwan Dr. Alex Wodak

MMT Program üPilot project in 2005 by v. Implemented at Taipei City (1 hospital) Taipei County (1 hospital) Taoyuan County (3 hospitals) Tainan County (1 hospital)

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

行政院衛生署桃園療養院 Drug abuse Treatment Team of TMH l. Set up drug abuse treatment team l. Devoted in drug treatment and research Aug, 2005 Oct, 2008 Psychiatrists 2 5 Psychiatric Nurses 1 8 Social workers 1 3 Psychologist 1 1 14

Drug abuse treatment Team

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 2021/6/7

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

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

Computer-aided drug administration

Real-time statistics

Cases overview

Individual treatment history

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

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

Case management 4 case managers (psychiatric nurses) Out patient counseling Phone call to : absentees for three days Remind OPD follow up

Case Number in Taoyuan Mental Hospital MMT program 4000 3500 Cumulated cases 3000 In treatment 2500 2000 1500 1000 500 0 2006/2/1 2007/2/1 2008/2/1

HIV prevalence (N=2854) 2021/6/7

HCV prevalence (N=2854) 2021/6/7

Daily attendance rate in the MMT program of TMH Max: 96. 3% Min: 67. 8% Average: 85. 2%

Retention Rate days

Urine Test for morphine and amphetamine week

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

OTI Employment rate (N=110)

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

OTI Daily Heroin Use Frequency (N=110)

OTI subscales (N=110) Lower score better outcome

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

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

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

media Prime Minister visited TMH and talked with an IDU

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

Winning awards

MMT Program üPilot projects in 2005 üIsland-wide after 2006. 07 ü 2008. 08 ü 23 counties ü 68 sites

MMT in Taiwan: Numbers of hospitals & clinics

MMT in Taiwan Case Number 2007. 01 -2008. 1. 9. Cumulative treatment cases On treatment cases

Gender ratio (Dec 31, 2007)

Age Distribution

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

Methadone Maintenance Therapy Worldwide (57 countries) Australia Austria Albania Andorra Belgium Bulgaria Bahrain Bermuda Bolivia Bosnia and Herzegovina Canada China Croatia Czech Denmark Ecuador France Germany Greece Hungary Hong Kong Iceland England Estonia Fiji Finland Indonesia Iran Israel Ireland

Methadone Maintenance Therapy Worldwide Italy Liechtenstein Luxemburg Lithuania Macedonia Malaysia Malta Namibia Nepal Norway Poland Portugal Scotland Slovenia Mexico Netherlands New Zealand Sweden Switzerland Slovak Republic South Africa Sri Lanka Spain Thailand Taiwan United Kingdom United states

MMT Program in Taiwan • 2004. 01 Awareness and Preparation v Refer to other countries’ experiences , eg. Australia, New York(U. S. ), Hong Kong • 2005. 01. Action plan • 2005. 11 Start “MMT pilot projects” projects in 1 city and 3 counties • 2006. 02. The first MMT case enrolled in Taoyuan Mental Hospital • 2006. 07 Expansion nationwide

Taiwan Taoyuan 2008 VS. 2007 ↓ 33% ↓ 40% 2007 VS. 2006 ↓ 34% ↓ 46% 2006 VS. 2005 ↓ 14% ↓ 36%

Criminal rate = cases/100, 000 population Taiwan Taoyuan 2007 VS 2006 4% 19. 7% 2006 VS 2005 8% 13%

MMT in Taoyuan 2006. 06 Taoyuan Mental Hospital (2006. 02 begin) 2006. 12 135(100%) 2007. 06 256(57%) 2007. 12 775(76%) Hsin Kuo Min General Hospital (2007. 07 begin) Taoyuan Armed Forces General (2006. 06 begin) Taoyuan Veterans Hospital (2006. 07 begin) Total 135 2008. 06 1182(75%) 1121(65%) 25(1. 6%) 223(13%) 112(25%) 141(14%) 163(10. 4%) 195(11%) 84(18%) 105(10%) 172(11%) 195(11%) 452 1021 1569 1734

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