Comparative Evaluation of PUSPENs and C&Cs

Study Overview
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Brief Summary
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This observational study compares the health and social outcomes between opioid-dependent individuals who are either recently released from a compulsory drug detention center (CDDC) or recently discharged from a voluntary treatment center (VTC) providing methadone maintenance therapy, in Malaysia.

Detailed Description
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In July 2010, the National Anti-Drug Agency of Malaysia (NADA) introduced a non-punitive system of treatment and care for people who use drugs, voluntary treatment centers (VTCs), called 'Cure & Care' clinics, offering free methadone maintenance therapy (MMT) to opioid-dependent drug users. These centers were opened alongside existing compulsory drug detention centers (CDDCs), where people who use drugs continue to be detained involuntarily without access to evidence-based treatment. Given that both of these programs are operated by NADA but espouse vastly different responses to drug use, we compared health and social outcomes between opioid-dependent individuals recently released from CDDCs and recently initiated into MMT in the new VTCs.

Official Title
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Comparing Health & Social Outcomes Between Opioid-Dependent Individuals in Compulsory Drug Rehabilitation Centers and Voluntary Drug Treatment Clinics in Klang Valley, Malaysia

Conditions
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Opioid-Related Disorders

Intervention / Treatment
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* Drug: Methadone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Meets Diagnostic and Statistical Manual-IV criteria for opioid dependence Physically and psychologically capable of understanding and undergoing informed consent process Within 90 days of release or discharge and intending to return to Klang Valley region For VTC arm, came to the C&C to start MMT

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Compulsory Drug Detention Center<br>Conventional drug treatment in Malaysia and Southeast Asia including detention for an average of 2 years, including educational and job skills programs and physical education. Medical therapies for treating substance use disorders, such as opioid-agonist treatment (OAT), are unavailable. | |
| Voluntary Treatment Center<br>Voluntary drug treatment facilities, called 'Cure and Care' centers in Malaysia, that provide methadone maintenance therapy in addition to psychosocial interventions, recreational programming, and vocational training, among other activities. | Drug: Methadone<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence of opioid use (urine-toxicology) |  | Year following release from CDDC or discharge from VTC | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence of any drug use (urine-toxicology) | Includes opioid, amphetamine and benzodiazepine use | Year following release from CDDC or discharge from VTC | 
| Occurrence of amphetamine use (urine-toxicology) |  | Year following release from CDDC or discharge from VTC | 
| Occurrence of benzodiazepine use (urine-toxicology) |  | Year following release from CDDC or discharge from VTC | 
| Occurrence of methadone use (urine-toxicology) | This is a proxy for linkage to methadone therapy | Year following release from CDDC or discharge from VTC | 
| Occurrence of buprenorphine use (urine-toxicology) | This is a proxy for linkage to buprenorphine therapy | Year following release from CDDC or discharge from VTC | 
| Occurrence of no-methadone use (urine-toxicology) | This is a proxy for retention in methadone therapy | Year following release from CDDC or discharge from VTC | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Malaysia, Asia, Southeast Asia, Compulsory Drug Detention Centers, Compulsory Centers for Drug Users, Methadone, Drug Relapse, Drug and Narcotic Control, Opiate Substitution Treatment, Prisons