Analyzing the relevance of needle exchange programme in the advent of methadone maintenance therapy

Aims: This study aims to determine the prevalence of relapse in those receiving MMT and study the harmful practices done during the relapses with their perceived causes. Background: Opioid dependence carries a high cost to society by resulting in unemployment, crimes and family disruption; not to mention transmission of diseases such as HIV and Hepatitis C. Harm reduction practices, namely Methadone Maintenance Therapy (MMT) and needle exchange programme has been in Malaysia since 2005. For MMT, relapse during treatment remains an issue that hinders successful outcome of reducing transmission of blood-borne infections. Methods: This is a mixed-method cross-sectional study done from June-July 2016. All MMT clients in primary care therapy centres in Kuala Nerus district, Terengganu, Malaysia who fulfilled the inclusion and exclusion criteria and consented were included. A semi-structured questionnaire was filled via face-to-face interview and reference to the case records was done. 122 questionnaires were assessed. Results: Response rate was 90.2%. Current relapse, defined as any episode of intake of heroine for the past one month after a period of abstinence was 34.4%. Of those relapsed, majority (78.6%) had Hepatitis C, 19.0% had HIV. Majority (97.6%) deny sharing needles during relapse, whom all attributed this due to ease of accessibility of needle exchange programme, and ability to withstand the urge for injection until getting a clean needle due to taking methadone. Conclusion: Relapse in opioid addiction remains high in those receiving MMT. Education to avoid harmful injecting practices is important even in this group. To achieve aim of harm reduction, MMT and needle exchange programme need to go hand.