Psychosocial Factors Contributing to Voluntary MMT Dose Reduction among Opioid-dependent Criminal Justice Populations in Ukraine

• In Event: Substance Use Disorders and Treatment Alternatives for Criminal Offender Populations

Abstract

Methadone maintenance therapy (MMT) is a cost-effective evidence-based approach to curbing opioid use disorders (OUDs) and the HIV epidemic that proliferates among people who inject drugs and criminal justice (CJ) populations. With optimal dose >80 mg, understanding why many Ukrainian patients voluntarily want to reduce their dose is highly important for MMT retention and implementation of CJ and drug use prevention efforts.
Using a method of constant comparison and symbolic interactionism as guiding conceptual frameworks, we used MAXQDA qualitative software to analyze data from 25 focus groups conducted in five Ukrainian cities from February-April 2013 with 199 individuals with OUDs with CJ history who received or considered MMT.
Results: Three key themes underlie participants’ desire to reduce MMT dose: 1) the quest for a ‘normal life’, uninterrupted by daily MMT site visits, police harassment, and loss of time, resources, and social capital; 2) coveted identity of feeling stronger than peers “needing” MMT; and 3) encouragement from trusted others (clinicians and close family) to get off MMT.
Implications: Co-occurring OUDs and HIV are major challenges to prison health reform in Ukraine. This study reveals the influence of psychosocial factors on MMT dosing and its effect on retention and subsequent CJ involvement.

Authors

• Julia Rozanova, Yale University, Yale AIDS Program

• Martha J. Bojko, Yale University, Yale AIDS Program

• Ruthanne Marcus, Yale University, Yale AIDS Program

• Faye S. Taxman, George Mason University

• Alyona Mazhnaya, ICF “International HIV/AIDS Alliance in Ukraine"

• Frederick L. Altice, Yale University, Yale AIDS Program