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by:
Putu Jerry Eka Rahayu P, MD

Methadone Maintenance Therapy Program
 

k Dengan Zinc

Drug abuse in Indonesia is increasingly rife. With the number of drug abuse is so the bad impact was more widespread. One of the adverse effects of narcotics, particularly injecting drug abuse is the spread of HIV / AIDS among users or not users like the wife / husband / partner and children of the user. As we already know about HIV / AIDS remains a global threat and has not found a satisfactory treatment. So it is important to prevent transmission. One of the efforts to prevent the spread of HIV / AIDS especially among injecting drug users (IDUs) is a harm reduction programs due to injecting drug use. There are 12 steps to overcome and one of them is the provision of methadone substitution therapy.

 

 

Substitution therapy that are familiar with the name of Methadone maintenance therapy program (MMP) is a therapy that aims to replace the use of substances such as heroin or morphine with methadone. Methadone is a chemical substance that is included in the opioid group similar to heroin or morphine. Methadone suppress the central nervous system function and has the effect of a strong painkiller. Although a party and work the same way with morphine or heroin but methadone have some differences which methadone easily digested orally (drink) is different from other opioid groups that do not have the characteristic that should be used by injection to obtain the desired effect. So, with the use of methadone as replacement therapy for other opioid type it will reduce injecting drug use and will ultimately reduce the incidence of HIV / AIDS. Unlike heroin or morphine clients who switched to methadone can live everyday life with more stable. In addition to its use is quite drunk once a day as well as the expected effects from the use of methadone is not the effect of "fly" as in the use of heroin or morphine it cause the client more active in everyday life and have a better quality of life. The other thing about methadone therapy is the treatment cost is relatively cheap when compared with injecting drug use.


There are several stages in methadone maintenance therapy. The initial stage is the stage of determining whether or not someone can enter in MMP. There are a number of inclusion and exclusion criteria are:

Inclusion criteria
Must meet the criteria of ICD-X for opioid dependence
Age 18 years or more, if not yet 18 years old should get a second opinion from another medical professional
Opioid dependence experienced within the last 12 months
Ever tried to stop using opioids at least one time

Exclusion criteria
Clients with severe physical illness
Psychosis
Mental retardation


The next stage is the provision of counseling, especially counseling on addiction and create a treatment plan. Methadone maintenance therapy phase itself is divided into 4 phases: initial dose, stabilization phase ,maintenance phase and reduction phase. In the initial dosing phase starts with a very low dose is 15-30 mg per day for later in the stabilization phase gradually increased doses of 5-10 mg every 3-5 days. The clients is said to reach the maintenance dose if the client has to feel good emotionally stable at work and social life. Average maintenance dose varied between 60-120 mg per day but varies greatly in each individual. The maintenance phase can last for many years until the client feels really stable. Methadone discontinuation phase or phases of reduction is also done in stages. Termination phase can be started if the client has been in stable condition, a minimum of 6 months in a state free of heroin, and patients in stable conditions for work and home environments. Decrease in the maximum dose of 10% and decrease the dose recommended is every 2 weeks. In therapy, clients will be regularly monitored their health and given counseling on a regular basis as well. In methadone maintenance therapy is sometimes raises some side effects like constipation (constipation), drowsiness, sweating, nausea, vomiting, sexual dysfunction, itching and acne. Methadone is given to clients in liquid form and in administered mixed with syrup until it reaches 100 cc to reduce the bitter taste. After taking methadone clients will be given candy to chew the aim is to increase the amount of saliva and thereby reducing the side effects of damage to the teeth.

 

Methadone maintenance therapy program in Bali was first held in Sanglah Hospital. Then later with the increasingly number of clients who want to undergo replacement therapy with methadone, satellites methadone services are builded. One of them MMP Puskesmas Kuta 1. Methadone maintenance therapy program that established since 5 September 2006 until now has about 250 clients and nowdays we have 23 active client who routinely obtain methadone substitution therapy every day. MMP Kuta I selected because easy access for clients, mostly working and living in the Kuta area so they do not have to travel long distances to get methadone and automatically will improve their compliance in methadone therapy and will ultimately impact on the improvement in their quality of life. In addition to provision of methadone, MMP Puskesmas Kuta I also provide counseling services, VCT, physical examination, laboratory, provision of sterile needles and condoms.


Given the many advantages of methadone compared to other injecting drug use such as heroin and morphine is not wrong if this substitution therapy is an option and so enthused. A substitution therapy is safe, inexpensive and allows users to live better. Esspecialy for foreigner please bring you doctor/clinic recomendation to us for the doses.

 

 

 

 

 

 

 

 

 

 

 

 

Government of Badung Regency
Health Department
Kuta I Public Health Center

Raya Kuta Street, No. 117, Badung, Bali, Indonesia
Phone (+62) 751311, Fax. (+62) 764735
Email: info@puskesmaskutasatu.com