[Treatment retention and evolution of clientele in a low threshold methadone substitution treatment program in Montreal].
OBJECTIVE
To evaluate client treatment retention and evolution in terms of living conditions, at-risk behaviours, and the use of psychoactive substances (PAS) over a one-year period, following admission into a low-threshold methadone program in Montreal.


METHODS
Individual interviews were administered to 114 clients from Relais-Méthadone (RM) at admission and one year after treatment initiation. Participants reported on PAS consumption and unsafe practices of drug use and sexual behaviours at high risk for transmission of HIV, sexually transmitted infections (STI) and other blood-borne viruses (BBV). Services utilized by clients were documented from Relais-Méthadone files. Bivariate analyses were used to compare data recorded at admission and one-year follow-up.


RESULTS
The treatment retention rate after one year at RM was 64%. However, by taking into account those clients who were transferred to a regular program during the study period, as well as those who voluntarily tapered their methadone treatment (16.7%), the status of 80.7% of clients demonstrated improvement one year after admission into treatment. Furthermore, the clients who remained in treatment for a year for whom information was available (n = 60) showed a tendency towards more stable living conditions. They also demonstrated a significant decrease in both the number of PAS injections and in risky behaviours related to drug consumption. A statistically significant decrease in the frequency of heroine and cocaine use was also observed. By contrast, however, two thirds of the individuals in treatment after a year (n = 42) maintained or increased their daily consumption of other PAS.


CONCLUSIONS
The treatment retention rate is comparable to other low or regular threshold substitution programs. The results support previous studies showing that the methadone substitution treatment reduces heroine and cocaine consumption, and decreases the number of unsafe behaviours that could potentially transmit HIV, STI and BBV for the majority of clients who remained in treatment. Future research could focus attention on people who abandon treatment and those who present at-risk behaviours during treatment.
Perreault
Michel
M
Hôpital Douglas et département de psychiatrie, Université McGill, Montreal (QC). michel.perreault@douglas.mcgill.ca
Héroux
Marie-Christine
MC
White
Noé Djawn
ND
Lauzon
Pierre
P
Mercier
Céline
C
Rousseau
Michel
M
D000293:Adolescent; D000328:Adult; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D040261:Harm Reduction; D015438:Health Behavior; D006556:Heroin Dependence / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D015397:Program Evaluation; D011792:Quebec / Q000453:epidemiology; D012309:Risk-Taking; D016320:Substance Abuse Treatment Centers / Q000379:methods / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D047568:Unsafe Sex / Q000517:prevention & control
D008691:Methadone