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Background:
Detention of people who use drugs in compulsory drug detention centres (CDDCs) is common throughout East and Southeast Asia. Pharmacological therapies for treating substance use disorders, like opioid agonist treatments with methadone, are generally unavailable in these settings. We use a unique opportunity to compare the timing and occurrence of opioid relapse using urine drug testing (UDT) in individuals transitioning from CDDCs versus methadone maintenance in voluntary drug treatment centres (VTCs).
Methods:
We conducted a two-arm, prospective observational study of opioiddependent individuals from Malaysian CDDCs and VTCs. Sequential sampling was used from August 2012 to September 2014. Baseline and semi-monthly behavioral assessments and UDTs were conducted for up to one year in the community. Relapse rates between the groups were compared using time-to-event methods. Findings: Screening occurred in 168 CDDC attendees and 113 VTC inpatients, with 89 (CDDC) and 95 (VTC) of these individuals having a baseline interview and at least one UDT. The baseline characteristics of the two groups were similar. In unadjusted analyses, CDDC participants had significantly more rapid relapse to opioid use postrelease compared to VTC participants (median: 31 vs 352 days, log rank test, p<0·0001). VTC participants had an 84% (95% C.I.: 75%-90%) decreased hazard of opioid relapse after adjustment for control variables and inverse propensity of treatment weights. Time-varying effect modeling revealed the largest hazard ratio reduction, at 91% (95% C.I.: 83%-96%), occurs during the first 50 days in the community.
Interpretation:
Opioid-dependent persons in CDDCs relapse to opioid use significantly sooner than those treated with evidence-based treatments like methadone, suggesting CDDCs have no role in the treatment of opioid use disorders.
Funding: The World Bank Group, Doris Duke Charitable Foundation, National Institute on Drug Abuse, National Institute of Mental Health, and the Malaysian Ministry of Higher Education.
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