Heroin use among clients receiving methadone treatment in Dar es Salaam Tanzania: a qualitative study
Keywords:Heroin, Dar es Salaam, Tanzania, Methadone treatment clinics
Background: Simultaneous heroin use among methadone-maintained clients is a recognized phenomenon worldwide. Tanzania is the first sub-Saharan African country to offer methadone treatment. This study explored reasons for heroin use among clients on methadone treatment clinics in Dar es Salaam, Tanzania.
Methods: This was exploratory cross-sectional study. Purposive sampling was used to select ten study participants. In in-depth interview guide was used to collect data. The interviews were conducted in Kiswahili and lasted for about sixty minutes. Audio-recordings of the interviews were transcribed verbatim and translated into English. Transcribed data was analysed and subjected to thematic analysis with the help of Nvivo 12 software.
Results: Many reasons were mentioned for concurrent use of heroin and methadone among clients on methadone treatment. Some of the mentioned reasons were inadequate methadone dose, treatment, healthcare providers’ attitudes, and healthcare provision environment, lack of family support, peer influence homeless and easy availability of heroin.
Conclusions: Different measures should be taken by methadone programs and stakeholders to overcome concurrent use of heroin and methadone among clients receiving methadone treatment.
Metzger DS, Zhang Y. Drug treatment as HIV prevention: Expanding treatment options. Current HIV/ AIDS Reports. 2010;7(4):220-5.
Sullivan L, Metzger DS, Fudala PJ, Fiellin DA. Decreasing international HIV transmission: The role of expanding access to opioid agonist therapies for injection drug users. Addiction. 2005;100:150-8.
Ross MW, McCurdy SA, Kilonzo GP, Williams ML, Leshabari MT. Drug use careers and blood-borne pathogen risk behavior in male and female Tanzanian heroin injectors. Am J Trop Med Hyg. 2008;79(3):338-43.
McCurdy SA, Williams ML, Kilonzo GP, Ross MW, Leshabari MT. Heroin and HIV risk in Dar es Salaam, Tanzania: youth hangouts, mageto and injecting practices. AIDS Care. 2005;17(1):S65-76.
UNODC. World Drug Report. 2016. Available at: https://www.unodc.org/wdr2016/. Accessed on 11 November 2022.
McCurdy SA, Ross MW, Kilonzo GP, Leshabari MT, Williams ML. HIV/AIDS and injection drug use in the neighborhoods of Dar es Salaam, Tanzania. Drug and Alcohol Dependence. 2006;82(1):S23-7.
TACAIDS Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of Chief Government Statistician Zanzibar (OCGSZ), & ICF International (ICF). Third Tanzania HIA/AIDS and malaria indicator survey 2011–2012. 2013. Available at: http://dhsprogram.com/pubs/pdf/AIS11/AIS11.pdf. Accessed on 11 November 2022.
Niaura R. Cognitive Social Learning and related perspectives on drug craving. Addiction. 2000;95(2):155-63.
Witkiewitz K, Marlatt GA. Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist. 2004;59:224-35.
Connock M, Juarez-Garcia A, Jowett S, et al. Methadone and Buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess. 2007;11:13-28.
Bruce RD. Methadone as HIV prevention: High volume methadone sites to decrease HIV incidence rates in resource limited settings. Int J Drug Policy. 2010;21(2):122-4.
Ball JC, Ross A, Dole VP. The effectiveness of methadone maintenance treatment: Patients, programs, services and outcome. xiv. New York: Springer-Verlag. 1991.
Mbatia J, Jenkins R, Singleton N, White B. Prevalence of alcohol consumption and hazardous drinking, tobacco and drug use in urban Tanzania, and their associated risk factors. Int J Environ Res Public Health. 2009;6:1991-2006.
Maman S, Mbwambo JK, Hogan NM, Kilonzo GP, Sweat M. Women’s barriers to HIV-1 testing and disclosure: Challenges for HIV-1 voluntary counseling and testing. AIDS Care. 2001;595-603.
Tiberio J, Lauren YI, Ndayongeje J, Welty AMS, Ngonyani A, Mwankemwa S, et al. Context and characteristics of illicit drug use incoastal and interior Tanzania. Int J Drug Policy. 2018;51:20-6.
Palamar JJ, Acosta P, Sharman S, Ompad DC, Cleland CM. Self-reported use of novel psychoactive substances among attendees of electronic dance music. Am J Drug Alcohol Abuse. 2016;42(6):624-32.
Ratliff EA, McCurdy SA, Mbwambo JKK, Lambdin BH, Voets A, Pont S, et al. An Overview of HIV prevention interventions for people who inject drugs in Tanzania. Adv Prev Med. 2013:183-7.
Wodak A, Maher L. The effectiveness of harm reduction in preventing HIV among injecting drug users. New South Wales Public Health Bulletin. 2010;21:69.
Guise A, Kazatchkine M, Rhodes T, Strathdee SA. Editorial commentary: successful methadone delivery in East Africa and its global implications. Clin Infect Dis. 2014;59(5):743-4.
Ng’wanakilala F. New treatment gives hope to East Africa’s drug users. Bull World Health Organ. 2013;91(2):89-90.
Bruce RD. Methadone as HIV Prevention: High Volume Methadone Sites to Decrease HIV Incidence Rates in Resource Limited Settings. Int J Drug Policy. 2011;21(2):122-4.
Lambdin BH, Masao F, Chang O, Kaduri P, Mbwambo J, Magimba A, et al. Methadone Treatment for HIV prevention-feasibility, retention, and predictors of attrition in Dar es Salaam, Tanzania: a retrospective cohort study. Clin Infect Dis. 2014;59:1-8.
Luo X, Zhao P, Gong X, Zhang L, Tang W, Zou X. Concurrent heroin use and correlates among methadone maintenance treatment clients: a 12-month follow-up study in Guangdong. Int J Env Res Public Health. 2016;13(3).
Lin C, Wu Z, Detels R. Opiate users’ perceived barriers against attending methadone maintenance therapy: a qualitative study in China. Subst Use Misuse. 2011;46(9):1190-8.
Masao FA. First International conference on drug policies in PRAIA. Comprehensive Interventions for Injection Drug Users: Tanzania Experiences on MAT & NSP Programs. 2013.
Li L, Lin C, Wan D, Zhang L, Lai W. Concurrent heroin use among methadone maintenance clients in China. Addict Behav. 2012;37(3):264-8.
Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: Available evidence to inform clinical practice and research. J Substance Abuse Treatment. 2005;28.
Senbanjo R, Wolff K, Marshall EJ, Strang J. Persistence of heroin use despite methadone treatment: Poor coping self-efficacy predicts continued heroin use. Drug Alcohol Rev. 2009;28:608-15.
Jamieson, Beals L. Literature Review: Methadone Maintenance Treatment; Office of Canada’s Drug Strategy, Health Canada. 2002.
Day E, Best D, George S, Copello. Drug Users’ Experiences of Prescribed Injectable Methadone: The Impact on Drug Use and Perceptions of Stability. J Drug Issues. 2007;37(2):341-55.
Tuten M, Jones HE. A partner’s drug-using status impacts women’s drug treatment outcome. Drug Alcohol Depend. 2003;70(3):327-30.
Wasserman DA, Stewart AL, Delucchi KL. Social support and abstinence from opiates and cocaine during opioid maintenance treatment. Drug Alcohol Depend. 2001;65(1):65-75.
De Leon G, Wexler HK. Heroin addiction: its relation to sexual behavior and sexual experience. J Abnorm Psychol. 1973;81(1):36-8.
Yee A, Danaee M, Loh HS, Sulaiman AH, Ng CG. Sexual dysfunction in heroin dependents: A comparison between methadone and buprenorphine maintenance treatment. PLoS One. 2016;11(1):1-12.
Jalal A. Sexual activity in relapse process among Iranian drug users. A qualitative study. Life Sci J. 2013;410-4.
Vijay M, Kiran KP, Narendra JS, Sudarshan AB, Karunakara A, Santosh TS, et al. Substance Use and Sexual Dysfunction; Review Article. J Evol Med Dent Sci. 2013;32(44):8624.
Hosseini SH, Isapour A, Tavakoli M, Taghipour M, Rasuli M.Erectile dysfunction in methadone maintenance patients: a cross sectional study in northern Iran. Iranian J Psychiatry. 2013;8(4):172-8.
Lions C, Carrieri MP, Michel L, Mora M, Marcellin F, Morel A, et al. Predictors of non-prescribed opioid use after one year of methadone treatment: An attributable-risk approach (ANRS-Methaville trial). Drug Alcohol Depend. 2014;135(1):1-8.
The United Republic of Tanzania. Ministry of Health and Social Welfare. Medically Assisted Treatment for Opioid Dependence Commission. A Clinical Guide for Zonal and Regional Referral Hospitals. Dar es Salaam, Tanzania. 2010.
Yusuph K, Negret I. Adolescents and Drug Abuse in Tanzania: History and Evolution. Adv Re. 2016;7(2):1-10.