Policies, adaptations, and ongoing challenges to naloxone, buprenorphine and nonprescription syringe access across four-states: Findings from an environmental scan and key informant interviews.

Background: As the US opioid-involved morbidity and mortality increase, uptake and implementation of evidence-based interventions remain key policy responses. Respond to Prevent was a multi-component, randomized trial implemented in four states and two large pharmacy chains with the aim of improving the pharmacy's capacity to provide naloxone, dispense buprenorphine, and sell nonprescription syringes (NPS). We sought to provide context and assess how policies and organizational practices affect communities and pharmacies across the study states. Methods: Using a multi-method approach we: 1) conducted an environmental scan of published literature and online materials spanning January 2015 to June 2021, 2) created timelines of key events pertaining to those policies and practices and 3) conducted semi-structured interviews with stakeholders (key informants) at the state and local levels (N=36) to provide further context for the policies and practices we discovered. Results: Key informants discussed state policies, pharmacy policies and local practices that facilitated access to naloxone, buprenorphine and NPSs. Interviewees from all states spoke about the impact of naloxone standing orders, active partnerships with community-based harm reduction organizations, and some federal and state policies like Medicaid coverage for naloxone and buprenorphine, and buprenorphine telehealth permissions as key facilitators. They also discussed patient stigma, access in rural settings, and high cost of medications as barriers. Conclusion: Findings underscore the important role harm reduction-related policies play in boosting and institutionalizing interventions in communities and pharmacies while also identifying structural barriers where more focused state and local attention is needed.

A review of factors associated with methadone maintenance treatment adherence and retention in Vietnam.

BACKGROUND: Starting in 2008, Vietnam's national MMT program expanded quickly, but it is struggling with increasing attrition rates and poor adherence among patients. Several studies have reported on MMT retention and adherence, but no overview has yet been published. The objective of this study is to fill that gap and to review factors associated with retention and adherence in MMT in Vietnam. METHODS: A systematic search was conducted using databases of literature - Pubmed, Cochrane, Scopus, Academic search premiere, and SoINDEX. Peer-reviewed empirical studies with full text in English discussing retention attrition and adherence regarding MMT in Vietnam were selected. The results were synthesized using qualitative methods. RESULTS: Adherence and retention rates varied among the 11 included studies. In general, patients in mountainous provinces had lower adherence and retention rates than those in big cities. Retention rates decreased with the studies' follow-up period and had a downward trend over time. Factors associated with adherence and retention can be classified into three groups: individual, community, and institutional factors. Important individual factors areage, education, awareness of MMT and HIV, and co-occurring disorders and comorbidities. Stigma is the major community risk factor, and methadone daily dose, the distance between home and clinic, and clinic's service hours are the three most important institutional factors. CONCLUSIONS: The literature reviewed identifies important factors associated with MMT adherence and retention in Vietnam. The findings suggest further research exploring both subjective and objective factors and more policies to remove social and structural barriers to enhance treatment outcomes.

Facing the future of substance use disorders treatment in Vietnam - A case study for international development and cooperation.

Vietnam made progress transitioning from a criminal justice to a health treatment response for substance use disorders (SUD) in recent years. This case study describes the evolution of Vietnam's SUD treatment system from 2005 to 2020 to understand and learn from the phases of its development. The case study is based on data from a predesigned interview guide for 47 respondents, literature and policy desk review and direct experience of the authors. Vietnam saw remarkable growth of opioid use disorder (OUD) treatment from 2005 when methadone was unavailable, to 2020 with 335 methadone clinics in all 63 provinces serving more than 52,200 patients. The growth in OUD treatment accounts for much of Vietnam's success managing its HIV epidemic for which injection drug use was a major vector. An unintended consequence, however, focused only on OUD as a strategy to address HIV and was unable to address multiple substances. Most elements of a modern evidence and community-based SUD treatment system exist in Vietnam; however, they are siloed and influenced by multiple government administrative jurisdictions. Faced with rising amphetamine and persistent alcohol use, the path ahead for Vietnam involves a choice between a reliance on compulsory rehabilitation centers or a plan to broaden the scope of substances and treatments, and further integrate with Vietnam's commune-based primary health system.