1. Change in Quality of Life in Heroin users receiving Methadone maintenance treatment(MMT) in Manipur Presenter : Dr Mohit Saini PGT, Dept. of Psychiatry RIMS, Imphal

2. Opioid dependence is a chronic relapsing disorder like other non- communicable diseases. Number of negative consequences are associated with it for the individual user, his family as well as society at large. (McLellan, 2000) National Household Survey (NHS) found prevalence of ‘current’ opioid use (defined as use for non-medical purpose at least once in the past month) to be 0.7 percent among the adult male population.(Ray, 2004) This translates into roughly 2 million current opioid users in the country. An assessment showed that about 25 percent or roughly 500,000 of these individuals were dependent on opioid. INTRODUCTION

3. Opioid Substitution Therapy (OST) is a well- proven long-term intervention for treatment of opioid dependence syndrome as well as for HIV prevention. It has also been shown to improve retention in treatment as well as improve the individual’s health, family, employment and legal problems. (Connock et al., 2007)

4. Methadone is most commonly used OST worldwide, followed by buprenorphine which is most commonly used in India. Permission to use methadone for OST was provided by the Drug Controller (General), India (DCGI) in 2009 Following which methadone maintenance treatment (MMT) project was developed by United Nations Office on Drugs and Crime (UNODC) in collaboration with National Drug Dependence Treatment Centre (NDDTC) All India Institute of Medical Sciences, New Delhi.

5. In this project a total of five centers were selected for implementation of the MMT in India. These include 2 centers in Punjab & 1 center each in Delhi, Mumbai, Imphal.

6. According to WHO, quality of life (QOL) is individuals' perception of their lives as related to their culture & value systems as well as their goals, expectations, standards & concerns. Research into QOL may deal with impact of diseases & treatments on patients’ everyday lives. There were increasing evidences that a good QOL is associated with successful treatment & better outcome in patients with opioid dependence. (Eklund et al., 1994) In order to determine impact of MMT on the lives of registered heroin users in Manipur, a QOL assessment was done.

7. PATIENTS AND METHODS Study was conducted from April 2015 to December 2015. Sample consisted of newly registered patients with opioid-dependence disorder, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V),who sought methadone maintenance treatment (MMT). Subjects were recruited from MMT centre of Department of Psychiatry and Drug De-addiction Centre, Regional Institute of Medical Sciences (RIMS), Imphal.

8. Social demographic data such as age at the time of enrollment, gender, marital status, employment and formal education were noted. Other variables of interest such as duration of illicit drug use, HIV status, Hepatitis C status, average dose per day consumed and legal issues related to drug use were also documented.

9. All participants were asked to complete the World Health Organization Quality of Life scale (WHO QOL-BREF), which includes 26 questions assessing overall quality of life & its four domains (physical health, psychological, social relationships & environment) and general health dimensions. Each domain was evaluated on a 0-100 scale. Higher scores indicate higher QOL.

10. QOL evaluation was done at three phases; prior to starting treatment, and at 3 & 6 months after beginning of treatment. Out of 27 newly registered patients, 3 patients did not respond to questionnaires completely & all data related to these patients was eliminated from the study. Once all data was gathered, statistical analysis was done using SPSS 21.

11. Result Of the 24 participants who completed the treatment protocol, 23 (95.8) were middle aged males and 12 (50%) were never married.

12. NPERCENT GENDER MALE2395.8 FEMALE14.2 AGE 20-25 520.8 26-30 14.2 31-35 729.2 36-40 625.0 41-50 520.8 MARITAL STATUS Divorced 28.3 Married 625.0 Never married 1250.0 Separated 312.5 Stay together 14.2 Socio-demographic characteristics (n=24)

13. NPERCENT EDUCATION JUST LITERATE 14.2 PRIMARY 28.3 HIGH SCHOOL5 20.8 HIGHER SECONDRY 729.2 GRADUATE 729.2 POST GRADUATE 28.3 OCCUPATION UNCLASSIFIED 729.2 UNSKILLED WORKER 28.3 SKILLED WORKER 625.0 SELF EMPLOYED 312.5 PROFESSIONAL 28.3 UNEMPLOYED 416.7 Socio-demographic characteristics (n=24) contd.

14. NPERCENT LIVING ARRANGEMENT Alone 12.5 Own house 29.2 With parents 58.3 HIV STATUS NO 1666.7 YES 833.3 HCV STATUS NO 1354.2 YES 1145.8 TOTAL DURATION(years) 1-5 312.5 6-10 1041.7 11-20 833.3 >20 312.5 Socio-demographic characteristics (n=24) contd.

15. NPERCENT PIECES PER DAY (1 ps= 50 mg of pure heroin) 3416.7 4-61458.2 7-10625.1 OTHER SUBSTANCE DEPENDENCE ALCOHOL 20.8 BENZODIAZIPINE 58.3 CANNABIS 25.0 SP TABLETS 20.8 INHALANT 4.2 TRAMADOL ABUSE 4.2 LEGAL ISSUES NO 1250.0 YES 1250.0 Socio-demographic characteristics (n=24) contd.

16. Total QOL score was improved from a mean of 211.5 ± 15.15 at pre-treatment to 249.89 ± 14.8 (p= 0.02) at 3 rd month after treatment. The improvement was maintained at 6 th month (M = 267.72 ± 19.07 (p= 0.02) assessment. There were no significant differences between mean scores at 3 rd month compared to 6 th month (p >0.5).

17. Fig: Changes of quality of life (overall) in substance-dependent patients who participated in methadone maintenance treatment (MMT) across assessment times.

18. MMT treatment was effective in improving QOL in all four domain in heroin users (physical, psychological, social & environmental relationship). There is no significant difference in improvement of QOL compared according to socio- demographic variables (p> 0.5)

19. Mean scores for Quality of Life (QoL) domains (n=24)

20. Fig: Changes of quality of life (domains) in substance-dependent patients who participated in methadone maintenance treatment (MMT) across assessment times.

21. DISCUSSION This study was designed to examine QOL among heroin users treated with methadone. Results showed a significant improvement in total QOL & all four individual domains. QOL score improved at 3 rd month of treatment & was maintained at 6 th month.

22. A study by Kobra et al. showed MMT was effective in improving physical & social domains only. In another study by Padaiga et al. showed significant improvements in physical, psychological & environmental domains of QOL, but no significant improvements in social domain. In 2007, study by Ponizovsky et al. found that methadone improved QOL of heroin users within 1 month of treatment, who remained stable until the end of programme.

23. Therefore, findings of this study is consistent with available literature, confirming the benefits of MMT in opioid dependents & improving their QOL.

24. CONCLUSION This study showed that MMT has a positive effect on QOL of opioid dependents. However, results should be interpreted & generalized with caution because of limitations of this study, which included small sample size, short duration & absence of control group. Future studies should also consider factors like personality and other mental health illnesses. It is important to emphasize on findings of this study for expanding the benefits of MMT in India.

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