Therapeutic Adherence with Methadone Treatment: Evaluation of therapeutic adherence and withdrawal management in methadone maintenance treatment program in Penang, Malaysia

Background: The objectives of the study include: 1) Therapeutic adherence of patients to the MMT program, and 2) National protocol comparison with that of active practices by practitioners and its impact on patient's compliance to therapy. Methodology: Medical records of all the outpatients from Jan. 2007 until May 2008 were reviewed. A year's retrospective and six months' prospective study was done. Exclusion was made for the defaulted out-patients (drop-outs, relapses etc.). Medical records were reviewed from all the three Government registered methadone clinics of Penang State, Malaysia. Results: A total of 283 patients were registered, 97.5% of which were males and 2.5% females. Only 215 patients' records were reviewed in the study. Majority of defaulted cases were untraceable (70.1%) and these drop-outs were found among the Chinese. Only 1 case was successfully treated. 54.0% were well adhered to the therapy and stayed over a year of treatment. 99 patients restarted the methadone treatment after an interval of 1-7 months. Withdrawal symptoms were observed among 57.3% of patients, while 89.8% of out-patients had medical complications during the methadone therapy with: musculo-skeletal problems (48.2%), neurological disorders (41.5%). Dose management showed that 69.4% of patients were on ineffective therapeutic comfort dose. 60.0% had positive urine analysis (>14 times) during 6 months of treatment, while a negative correlation (r = -0.492) was found between counselling and positive urine analysis with 24.2% shared variance. Regression modelling identified (R-square = 0.793) 79.3% functional change in the adherence to therapy with p < 0.001 and CI 95%. Conclusions: High rate of defaulted cases were observed as compared to the therapeutic adherence to MMT program. Inconsistent practices were found. Although the practices were inconsistent to National Protocol, it was found that there is a strong need to review the National Guidelines on present evidence-based therapeutic approach. To control the positive urine analysis further research is needed to identify the social stigma among the patients during the treatment paradigm.