Trải nghiệm cai nghiện bằng methadone lợi ích, thách thức và ước vọng

Nghign cOfu Gla d i n h vk G i a i sef - 2 Trai nghiem cai nghien bdng Methadone: Lai ich, Ihdch thuc va udc vgng Nguyin Le Hoai Anh TnrOng Dai tipc Sir pham Ha NOi Trjnh Minh Phifdng, Le Mai Phi/dng Trung ISm Nghifin cinj Phfit t n l n Y tg Cflng dfing Nguyen Tien Dung Tnjng ISm Nghifin cini vd Tir vdn Phat tnin Cflng ddng Thing Long Lung Bich Ngoc Trung tfim Nghifin ciru v i OSo I90 HIV/AIDS TniOig Dai hoc v HS Nfli Tdm t&t: DUa tren dfl lieu dit'ii da dan tgc hoc ve giam hgi Methadone trUdng Dai hoc Y vk Trung tam nghien ciiu Phat tnen Y te cong dong (CCRD) thUc hien tai qufin Le Chan va Ngo Quyen thSnh Hai Phong nAm 2009, hki vi^t tim hieu nhflng trai nghiem cua nhflng ngUdi cai nghien qua trinh tham gia vko ChUdng trinh dieu trj Methadone dUdc trien khai tai Viet Nam nam 2008 Ket qua nghien ciiu cho th&'y m^c du ton tai mot so' han che qua trinh dieu tri, nhUng nhflng ngUdi cai nghien bSng Methadone da the hi^n su hai long ve tinh trang sflc khoe to't hdn, ho cung gianh lai dUde niem tin cua gia dinh, ban b6, cong dong vk c6 nhieu hy vong vao viee tfl bo dUdc ma tuy, Nghien cflu cho r&ng de Chuong trinh Methadone dat hieu qua, c^n coi quyen tU quyet cua ngUdi dieu tri Methadone va giai quye't dUdc nhflng kho khSn, thaeh thfle sinh qua trinh cai nghien b&ng Methadone Tif khoa: Methadone; Dieu tri Methadone; Ma tuy; HIV/AIDS N g u y e n I,r Hoai Anh va c a c t a c gia 33 Md dau Tai Viet Nam, dich HIV/AIDS van tap trung chii yfi'u m6t s6 nhom hanh vi nguy ca cao irong nhom nghien chich ma luy ehifi'm chu y^u vdi ty le nhifim HIV Ik 28,61% (Nguyen Van Kinh, 2004:9) Tfl nam 1998 chfnh phii da c6 cac van ban luat chinh sach, cai nghien ma cho nhom nghifin la mni nhung trpng tam nham ung phd v6i cac dai dich HIV Chuong trinh hanh dflng qu6'c gia vfi HIV nam 2010 va ldm nhin 2020 bao g6m chucmg trinh hanh dflng, chuong trinh hanh dflng sfl' tap trung vao cac hoat dflng can thifip giam hai lay nhifim HIV Bfin canh cac chuong hinh giam hai nhu phat bcfm kim tifim mifin phi da dugc ap dung ttr trudc, Vifit Nam da budc ddu dua vao su dung thii nghifim cha't cai nghifin thay thfi' Methadone Dugc sij" dung Idn ddu tifin tai My vdi muc dich cai nghifin, hifin Methadone da dugc sfl dung rflng rai tai nhi^u qufl'e gia trfin ihfi' gidi Tai Viet Nam, Chuong trinh Methadone dugc trifi'n khai ddu tifin lai Hai Phong vao thang nam 2008 va lai phd H6 Chi Mmh vao thdng nam 2008 Cho tdi nay, cd kha nhi^u chucfng trinh danh gia hifiu qua cac Chucmg trinh cai nghifin bang cha't thay thfi' Methadone sau mflt thM gian thfl nghifim Tuy nhifin, kha ft cac nghifin ciru danh gia chuong trinh dieu trj Methadone tfl goc dfl ctia ngudi dieu tri Methadone Bai vifi't tap trung phan tfch nhiJng trai nghifim ctia ngudi cai nghifin sufl't qua trinh dilu tri va ttr nhiing Irai nghifim ctia nhflng ngudi "trong cudc", mong mud'n nham gdp p h ^ cai thifin cac chuong trinh dieu tri Methadone thdi gian tdi chuong trinh dang cd ke'hoach nhan rflng toan bfl cac tinh Ihanh khac irong ca nudc Nghifin cflu nham tra Idi hai cau hdi sau: i) Trai nghiem cua ngudi di^u tri Methadone? ii) Nhirng ngudi difiu tri Methadone gap nhiing Ihach thuc nhu thfi' nao qua trinh thuc hifin? Phuong phap Vdi sir cho phep ctia STAR, nghifin ciiu cua chung ifli sfl dung du Ueu Ifl nghifin ciru di^n da dan tflc hoc vi giam hai - Methadone u-udng Dai hgc Y va CCRD ihirc hifin lai quan Le Chan va quan Ngd Quyen, phfl' Hai Phong tfl thang de'n thang nam 2009 Ddi lugng nghifin cflu la ngudi di^u tri Methadone; gia dinh ngudi su dung Methadone va ngudi su dung heroin dugc luyfi'n chon cac nghien cuu vien diln da lai cac phong kham, cac quan nudc xung quanh co sd dilu trj, cac diem nong vl ma tfly va qua gidi Ihifiu 1 34 NghiSn cUu Gla dinh v4 Gldl QuyS'n 22, so 6, tr 132-144 Du lifiu g^^m 33 giai bang phdng va'n sau va 13 nhat k^ thirc dia cu Ih^ nhu sau: I'hdng vfl'n Ijch sfl ddi sfl'ng: iSn vdi ngudi difiu tri Methadone (tnii nghifim cai nghifin lai cac trung tam cai nghifin \ii chudng trinh Methadone) \;i Idn vdi ngudi nghifin ma tfly (irai nghifim cai nghifin lai cac trung tam) phdng va'n sau vdi gia dinh ngudi su dung Methadone va 13 nhai ky thirc dia (NKTD) cua nghiCn cflu vifin lai phdng khdm quan ,c C 'han va nghifin cflu vifin tai phdng kham quan Ngd Quy^n, vdi nhflng quan sal, ciim nhan suy nghT rifing cua nha nghifin cflu vi nhflng hoat dflng difin lai cd sd dicu iri nhung cau chuyfin ngoai quan nudc; nhung trao drfi v^ Methadone, nhung md'i quan hfi xa hdi thai dd, hanh vi cua ngudi then trj Ket qu^ 3.1 Quy Irinh tham gia MIO chmmR trmh dieu tri Mtlhadone Hdu hot ngudi tham gia difiu tri NktlLklnne dfiu fl-ong dd ludi tfl 30-40 ludi v^ cd thdi gian nghifin ma luy nhifiu nam Nam chi^m da s6 hdu hfi'l chua cd gia dinh vk khdng cd vific lam Cdc thdng lin m^ nguM di^u tri Methadone lifi'p nhan diu khdng "chi'nh thflc", ma chii yfi'u thdng qua vifin gia dinh, ban be, can bd y le (quen biS'l \(S gia dinh) \ on la nhirng ngucri nhan duac thdng tin qua cac md'i quan hfi \a hdi cua ban ihSn ho Chinh vi \ay cac Ihdng tin m^ nhung ngudi nghifin ma niy nhan dugc 1^ chira d:i\ dii va thifi'u chfnh xac, nhifin cac ihdng lin nky cung giup hp bifit vl Methadone, lac dung chi'nh, tdc dung phu va hifiu qua da dugc bifi't dfi'n Nhiing thflng tin lao cho ngudi nghicii ihfini tin tudng, dac bifit la dd'i vdi nhung ngucri nhan ihdng tin tfl ban be nghifin da sfl dung Methadone dfi' ifl dd cam tha'y yfin tam, mong mud'n iham gia vao chucmg trinh Dfi tham gia vao chuong trinh dilu tri Methadone, ngucri nghifin cdn phai dap ung dugc mdt sfl' lifiu chf nha'l dinh gdm cd: ludi tfl 18 ird Ifin, dd'i vdi ngudi tfl 16-18 ludi phai cd ngudi giam hd hgp phap ciia ngudi dd tu nguyfin va cam kfi'l bang van ban \c man ihii dilu tri nghifin cac cac dang Ihuflc phien (CDTP) bang thud'c Methadone, khdng cd hknh vi vi pham phap luat, du sflc khde, khdng mac bfinh man tfnh Bfin canh cac lieu chi chung, cac dd'i tugng sc dugc uu tifin tham gia chuong trinh nfi'u dap ung dugc cac lifiu chf rifing nhu sfl dung cha't dang ihud'c phifin bang dudng tifim ehi'ch, nghifin ft nha'l nam, cai bang nhilu Mn nhung vdn tai nghifin Ngudi dilu tri Methadone dugc quyfi'l dinh chi'nh vific tham gia dilu tri tai trung tam Tuy nhifin, ngudi nha, dac bifit la ngudi me, lai chi'nh la ngudi tham gia vific hoan ihifin hd so dang ky tham gia chuong irinh Nguyen Le Hoai Anh va cac tac gia 135 Cac thii tue dang ky tham gia gdm cd xdc nhan cua phudng, tram y l^, don cam kfi't cua gia dinh den lu nguyfin tham gia chuong irinh Da sd nhan xei thdi gian xet duyfil hd sd dai va kfio dai khoang 1-2 thdng trudc ngudi nghifin dugc ggi Ifin phong va'n di quyfi't dinh tham gia chuong trinh Dilu khifi'n cho ngudi tham gia cam tha'y chdn nan "Ldu ldm em cdm tudng phdi de'n 2- thdng gi day Em cdm tudng thdi gian di ldu, me em ddng ki ddng ki Idu ldm rc'ii the nliiOig vdo gap bao nhiiu Idn md khdng dirge Ngciy ndo cung di md ngdy ndo hai me cffng dien thogi rio rdt the md cffng khdng ditcrc Em nghi Idm md thudc ndy khd khdn din mitc vdo khd thi Cir thi Idm liic em nglu em cffng ndn thdl nhung em khdng ddm noi vi str ndi anh d'y ccm ndn qud" (Vo ngudi dilu trj Methadone) 3.2 Trai nghiem ctia ngudi nghien ve nhCrng Igi ich ciia Chucmg trinh Methadone Cam \uc phd bifi'n nha't ma da so nhflng ngudi tham gia chuong trinh dieu tri Methadone trai qua dd chi'nh \k hg cam tha'y Methadone da cd nhung tac ddng anh hudng ra'l Idn tdi cudc sdng ciia hg "Anh cd ndi, thitc theo quan diem ciia da sd nhffng ngitdi a ddy nhu anh thi anh thdy methadone cd lac dgng rdt Idn din cudc ddi nhffng ngitdi nhu cdc anh " (Tn'ch NKTD) Mdt sfl' ngudi cho bifi't su thay ddi cua ban than duac chap nhan cho dieu tri Methadone dugc vf nhu "budc vao cudc sd'ng mdi" va "lhay ddi hoan toan" (Trfch NKTD) Thay doi bdn thdn vd md'i quan hi vdi gia dinh Trai nghifim rd rang nhat, dilu khifi'n ngudi dilu tri Methadone cam th^y hai long nha't la Methadone da tao ihay ddi, dem lai Igi fch cho chi'nh ban than va gia dinh hg Trudc hfi't, ngudi nghien da giam va ngimg sudung heroin mgt each tfl tfl, nhe nhang, khdng phai trai qua Irang thai vat va cua hdi chflng cai Vdi nhung ngudi mdi bat ddu dilu tri Methadone thi hg vdn sfl dung dong thdi heroin Tuy nhien chi sau thdi gian ngdn hg da giam lieu va ngiing hin vific sfl dung heroin: "Din dgt din lieu 30mg thi anh chl hit Idnlngdy lhay vi Idn nhu trudc, din 70 mg ihi anh chl ddng man 1-2 lan heroin vd dgt 120 mg anh dd khdng diing heroin nffa Iff sau khoang thdng san diing Methadone, anh khdng cdn ddng Igi heroin, anh bdt ddu ud'ng Methadone din gid dd ditac gdn I ndm " (Trich NKTD) TSl ca nhflng ngudi dugc tham gia vao chuong innh Methadone diu da trai qua rd't nhilu Idn cai nghifin khac nhu tu cai bo a gia dinh, cai cd bac sy hd trg tai nha, cai d trung lam dfi'n vai chitc 136 Nghidn cflu Gia dinh vi Gldl Quyd'n 22 s6'6, tr 132-144 Idn hp cung da giam vk ngflng sfl dung mfll thdi gian, ft ihi mdt ludn, nhi(Su thi nam nhflng kfi'l qua cud'i cung hg diu tai nghifin Methadone cung gid'ng vdi cdc hinh thflc cai nghifin khac 1^ nhdm dfi ngudi nghifin tfl bd vific su dung heroin, nhung khac vdi nhung hinh ihtJc cai nghifin khac la khdng sfl dung heroin, cdn Methadone vdn phai sudung iiidi loai thud'c thay thfi'cho heroin nhung fi tdc hai hon heroin vd cd str kilm so;ii chat che vl mat y lO Han nfla, cai bang Methadone, ngudi nghifin khdng phai trai qua nhung hdi chflng cai hfit sflc kho sd, vdt va mk vfl'n lii ndi am anh so hai vk la mdt irong nhflng riio can ma ho khd vu