Involuntary versus voluntary detoxification from methadone maintenance treatment: the importance of choice

FRANÇAIS :
Exécuté à partir d'une population de 233 patients sous méthadone en traitement dans différents centres de San Francisco, ce rapport s'étaye sur un échantillon de 10 patients entrés volontairement dans ce programme et 30 involontairement, en raison d'une suppression de subventions des traitements à la méthadone et qui ont été contraints à la désintoxication, ne pouvant payer les 225 ou 300$ mensuels par eux-mêmes. Beaucoup de ces patients sont retournés à des activités illégales pour payer les frais demandés. L'abandon de la méthadone les a souvent conduits à reprendre de l'héroïne. Ceux qui ont choisi la désintoxication étaient des patients financièrement plus stables et qui souvent n'ont pas désiré d'autres aides à la clinique. Il est démontré ici que la suppression de soins subventionnés exclut les plus démunis, les rejetant dans la toxicomanie lourde, la délinquance et les exposant au VIH.
ENGLISH:
The authors report on a subset of data from a three-year qualitative and quantitative study of 233 injection drug users (IDUs) in and out of methadone maintenance treatment (MMT) programs in the San Francisco Bay Area. We analyzed data from ten study participants detoxified from their MMT programs voluntarily and thirty involuntarily detoxified due to the defunding of their subsidized MMT slots. All of the study participants reported benefits from MMT program participation including decreased drug use or abstinence; decreased illicit activity; increased ability to maintain or initiate conventional employment; and increased ability to respond to parenting and family obligations. Those who were involuntarily detoxified from MMT programs experienced severe destabilization. Many were financially unstable and dependent on subsidized drug treatment prior to defunding. Several defunded participants were detoxified because they could not afford private fees ( others reverted to illicit activities to pay clinic fees. The majority increased heroin use, illicit activity, and experienced economic and personal harm as a result of involuntary detoxification from MMT. Those who chose to detoxify from MMT programs reported longer treatment histories and greater financial stability. Most described methadone as a prescription-like drug; ancillary clinic services, such as counseling, were unnecessary and undesired by many who voluntarily detoxified. Those who remained opioid-free reported that slow detoxifications from MMT, with client input and control, were necessary to prevent relapse. Study participants in this group who returned to the intermittent use of heroin had the financial resources to re-enroll in MMT. None of the voluntarily detoxified study participants returned to daily heroin use or illicit activity when leaving MMT programs.