Trải nghiệm cai nghiện bằng Methadone: Lợi ích, thách thức và ước vọng

Nghign cOfu<br /> Gla d i n h vk G i a i<br /> sef 6 - 2 0 1 2<br /> <br /> <br /> <br /> <br /> Trai nghiem cai nghien bdng Methadone:<br /> Lai ich, Ihdch thuc va udc vgng<br /> <br /> Nguyin Le Hoai Anh<br /> TnrOng Dai tipc Sir pham Ha NOi<br /> Trjnh Minh Phifdng, Le Mai Phi/dng<br /> Trung ISm Nghifin cinj Phfit t n l n Y tg Cflng dfing<br /> Nguyen Tien Dung<br /> Tnjng ISm Nghifin cini vd Tir vdn Phat tnin Cflng ddng Thing Long<br /> Lung Bich Ngoc<br /> Trung tfim Nghifin ciru v i OSo I90 HIV/AIDS. TniOig Dai hoc v HS Nfli<br /> <br /> <br /> <br /> <br /> Tdm t&t: DUa tren dfl lieu dit'ii da dan tgc hoc ve giam hgi -<br /> Methadone do trUdng Dai hoc Y vk Trung tam nghien ciiu Phat<br /> tnen Y te cong dong (CCRD) thUc hien tai 2 qufin Le Chan va<br /> Ngo Quyen. thSnh pho Hai Phong nAm 2009, hki vi^t tim hieu<br /> nhflng trai nghiem cua nhflng ngUdi cai nghien trong qua trinh<br /> tham gia vko ChUdng trinh dieu trj Methadone dUdc trien khai<br /> tai Viet Nam nam 2008. Ket qua nghien ciiu cho th&'y m^c du<br /> con ton tai mot so' han che trong qua trinh dieu tri, nhUng<br /> nhflng ngUdi cai nghien bSng Methadone da the hi^n su hai long<br /> ve tinh trang sflc khoe to't hdn, ho cung gianh lai dUde niem tin<br /> cua gia dinh, ban b6, cong dong vk c6 nhieu hy vong vao viee tfl<br /> bo dUdc ma tuy, Nghien cflu nay cho r&ng de Chuong trinh<br /> Methadone dat hieu qua, c^n coi trong quyen tU quyet cua ngUdi<br /> dieu tri Methadone va giai quye't dUdc nhflng kho khSn, thaeh<br /> thfle nay sinh trong qua trinh cai nghien b&ng Methadone.<br /> <br /> Tif khoa: Methadone; Dieu tri Methadone; Ma tuy; HIV/AIDS.<br />  N g u y e n I,r Hoai Anh va c a c t a c gia 1 33<br /> <br /> 1. Md dau<br /> <br /> Tai Viet Nam, dich HIV/AIDS van tap trung chii yfi'u trong m6t s6<br /> nhom hanh vi nguy ca cao irong do nhom nghien chich ma luy ehifi'm chu<br /> y^u vdi ty le nhifim HIV Ik 28,61% (Nguyen Van Kinh, 2004:9). Tfl nam<br /> 1998. chfnh phii da c6 cac van ban luat. chinh sach, trong do cai nghien<br /> ma tuy cho nhom nghifin la mni trong nhung trpng tam. nham ung phd v6i<br /> cac dai dich HIV. Chuong trinh hanh dflng qu6'c gia vfi HIV nam 2010 va<br /> ldm nhin 2020 bao g6m 9 chucmg trinh hanh dflng, trong do chuong trinh<br /> hanh dflng sfl' 2 tap trung vao cac hoat dflng can thifip giam hai trong lay<br /> nhifim HIV. Bfin canh cac chuong hinh giam hai nhu phat bcfm kim tifim<br /> mifin phi da dugc ap dung ttr trudc, Vifit Nam da budc ddu dua vao su dung<br /> thii nghifim cha't cai nghifin thay thfi' Methadone. Dugc sij" dung Idn ddu<br /> tifin tai My vdi muc dich cai nghifin, hifin nay. Methadone da dugc sfl dung<br /> rflng rai tai nhi^u qufl'e gia trfin ihfi' gidi. Tai Viet Nam, Chuong trinh<br /> Methadone dugc trifi'n khai ddu tifin lai Hai Phong vao thang 4 nam 2008<br /> va lai thanh phd H6 Chi Mmh vao thdng 5 nam 2008.<br /> <br /> Cho tdi nay, cd kha nhi^u chucfng trinh danh gia hifiu qua cac Chucmg<br /> trinh cai nghifin bang cha't thay thfi' Methadone sau mflt thM gian thfl<br /> nghifim. Tuy nhifin, con kha ft cac nghifin ciru danh gia chuong trinh dieu trj<br /> Methadone tfl goc dfl ctia ngudi dieu tri Methadone. Bai vifi't nay tap trung<br /> phan tfch nhiJng trai nghifim ctia ngudi cai nghifin trong sufl't qua trinh dilu<br /> tri va ttr nhiing Irai nghifim ctia nhflng ngudi "trong cudc", mong mud'n<br /> nham gdp p h ^ cai thifin cac chuong trinh dieu tri Methadone trong thdi<br /> gian tdi khi chuong trinh nay dang cd ke'hoach nhan rflng ra toan bfl cac tinh<br /> Ihanh khac irong ca nudc. Nghifin cflu nham tra Idi hai cau hdi sau: i) Trai<br /> nghiem cua ngudi di^u tri Methadone? ii) Nhirng ngudi difiu tri Methadone<br /> gap nhiing Ihach thuc nhu thfi' nao trong qua trinh thuc hifin?<br /> <br /> 2. Phuong phap<br /> <br /> Vdi sir cho phep ctia STAR, nghifin ciiu cua chung ifli sfl dung du Ueu<br /> Ifl nghifin ciru di^n da dan tflc hoc vi giam hai - Methadone do u-udng Dai<br /> hgc Y va CCRD ihirc hifin lai quan Le Chan va quan Ngd Quyen, thanh<br /> phfl' Hai Phong tfl thang 2 de'n thang 9 nam 2009. Ddi lugng nghifin cflu la<br /> ngudi di^u tri Methadone; gia dinh ngudi su dung Methadone va ngudi su<br /> dung heroin dugc luyfi'n chon khi cac nghien cuu vien diln da lai cac<br /> phong kham, cac quan nudc xung quanh co sd dilu trj, cac diem nong vl<br /> ma tfly va qua gidi Ihifiu.<br /> 1 34 NghiSn cUu Gla dinh v4 Gldl. QuyS'n 22, so 6, tr. 132-144<br /> <br /> <br /> Du lifiu g^^m 33 giai bang phdng va'n sau va 13 nhat k^ thirc dia. cu Ih^<br /> nhu sau: I'hdng vfl'n Ijch sfl ddi sfl'ng: 3 iSn vdi 9 ngudi difiu tri Methadone<br /> (tnii nghifim cai nghifin lai cac trung tam cai nghifin \ii chudng trinh<br /> Methadone) \;i 2 Idn vdi 2 ngudi nghifin ma tfly (irai nghifim cai nghifin<br /> lai cac trung tam). 6 phdng va'n sau vdi gia dinh ngudi su dung Methadone<br /> va 13 nhai ky thirc dia (NKTD) cua 2 nghiCn cflu vifin lai phdng khdm<br /> quan 1 ,c C 'han va 1 nghifin cflu vifin tai phdng kham quan Ngd Quy^n, vdi<br /> nhflng quan sal, ciim nhan. suy nghT rifing cua nha nghifin cflu vi nhflng<br /> hoat dflng difin ra lai cd sd dicu iri. nhung cau chuyfin ngoai quan nudc;<br /> nhung trao drfi v^ Methadone, nhung md'i quan hfi xa hdi. thai dd, hanh vi<br /> cua ngudi then trj.<br /> <br /> 3. Ket qu^<br /> <br /> 3.1. Quy Irinh tham gia MIO chmmR trmh dieu tri Mtlhadone<br /> Hdu hot ngudi tham gia difiu tri NktlLklnne dfiu fl-ong dd ludi tfl 30-40<br /> ludi v^ cd thdi gian nghifin ma luy nhifiu nam. Nam chi^m da s6. hdu hfi'l<br /> chua cd gia dinh vk khdng cd vific lam. Cdc thdng lin m^ nguM di^u tri<br /> Methadone lifi'p nhan diu khdng "chi'nh thflc", ma chii yfi'u thdng qua thanh<br /> vifin gia dinh, ban be, can bd y le (quen biS'l \(S gia dinh) \ on la nhirng ngucri<br /> nhan duac thdng tin qua cac md'i quan hfi \a hdi cua ban ihSn ho. Chinh vi<br /> \ay. cac Ihdng tin m^ nhung ngudi nghifin ma niy nhan dugc 1^ chira d:i\ dii<br /> va thifi'u chfnh xac, tuy nhifin cac ihdng lin nky cung giup hp bifit vl<br /> Methadone, lac dung chi'nh, tdc dung phu va hifiu qua da dugc bifi't dfi'n.<br /> Nhiing thflng tin nay lao cho ngudi nghicii ihfini tin tudng, dac bifit la dd'i<br /> vdi nhung ngucri nhan ihdng tin tfl ban be nghifin da sfl dung Methadone dfi'<br /> ifl dd cam tha'y yfin tam, mong mud'n iham gia vao chucmg trinh.<br /> <br /> Dfi tham gia vao chuong trinh dilu tri Methadone, ngucri nghifin cdn<br /> phai dap ung dugc mdt sfl' lifiu chf nha'l dinh gdm cd: ludi tfl 18 ird Ifin, dd'i<br /> vdi ngudi tfl 16-18 ludi phai cd ngudi giam hd hgp phap ciia ngudi dd tu<br /> nguyfin va cam kfi'l bang van ban \c man ihii dilu tri nghifin cac cac dang<br /> Ihuflc phien (CDTP) bang thud'c Methadone, khdng cd hknh vi vi pham<br /> phap luat, du sflc khde, khdng mac bfinh man tfnh. Bfin canh cac lieu chi<br /> chung, cac dd'i tugng sc dugc uu tifin tham gia chuong trinh nfi'u dap ung<br /> dugc cac lifiu chf rifing nhu sfl dung cha't dang ihud'c phifin bang dudng<br /> tifim ehi'ch, nghifin ft nha'l 3 nam, cai bang nhilu Mn nhung vdn tai nghifin.<br /> Ngudi dilu tri Methadone dugc quyfi'l dinh chi'nh trong vific tham gia<br /> dilu tri tai trung tam. Tuy nhifin, ngudi nha, dac bifit la ngudi me, lai chi'nh<br /> la ngudi tham gia vific hoan ihifin hd so dang ky tham gia chuong irinh.<br />  Nguyen Le Hoai Anh va cac tac gia 135<br /> <br /> Cac thii tue dang ky tham gia gdm cd xdc nhan cua phudng, tram y l^, don<br /> cam kfi't cua gia dinh. den lu nguyfin tham gia chuong irinh. Da sd nhan<br /> xei thdi gian xet duyfil hd sd dai va kfio dai khoang 1-2 thdng trudc khi<br /> ngudi nghifin dugc ggi Ifin phong va'n di quyfi't dinh tham gia chuong trinh.<br /> Dilu nay khifi'n cho ngudi tham gia cam tha'y chdn nan. "Ldu ldm. em cdm<br /> tudng phdi de'n 2- 3 thdng gi day. Em cdm tudng thdi gian di ldu, me em<br /> ddng ki. ddng ki Idu ldm rc'ii the nliiOig vdo gap bao nhiiu Idn md khdng<br /> dirge. Ngciy ndo cung di. md ngdy ndo hai me con cffng dien thogi rio rdt<br /> the md cffng khdng ditcrc. Em nghi Idm sao md thudc ndy khd khdn din<br /> mitc do vdo khd thi... Cir thi Idm liic em nglu em cffng ndn thdl nhung em<br /> khdng ddm noi ra vi str ndi ra anh d'y ccm ndn qud" (Vo ngudi dilu trj<br /> Methadone).<br /> <br /> 3.2. Trai nghiem ctia ngudi nghien ve nhCrng Igi ich ciia Chucmg<br /> trinh Methadone<br /> Cam \uc phd bifi'n nha't ma da so nhflng ngudi tham gia chuong trinh<br /> dieu tri Methadone trai qua dd chi'nh \k hg cam tha'y Methadone da cd<br /> nhung tac ddng. anh hudng ra'l Idn tdi cudc sdng ciia hg "Anh cd ndi, thitc<br /> ra theo quan diem ciia da sd nhffng ngitdi a ddy nhu anh thi anh thdy<br /> methadone cd lac dgng rdt Idn din cudc ddi nhffng ngitdi nhu cdc anh "<br /> (Tn'ch NKTD). Mdt sfl' ngudi cho bifi't su thay ddi cua ban than khi duac<br /> chap nhan cho dieu tri Methadone dugc vf nhu "budc vao cudc sd'ng mdi"<br /> va "lhay ddi hoan toan" (Trfch NKTD).<br /> <br /> Thay doi bdn thdn vd md'i quan hi vdi gia dinh<br /> Trai nghifim rd rang nhat, dilu khifi'n ngudi dilu tri Methadone cam<br /> th^y hai long nha't la Methadone da tao ra ihay ddi, dem lai Igi fch cho<br /> chi'nh ban than va gia dinh hg. Trudc hfi't, ngudi nghien da giam va ngimg<br /> sudung heroin mgt each tfl tfl, nhe nhang, khdng phai trai qua Irang thai<br /> vat va cua hdi chflng cai. Vdi nhung ngudi mdi bat ddu dilu tri Methadone<br /> thi hg vdn sfl dung dong thdi heroin. Tuy nhien chi sau thdi gian ngdn hg<br /> da giam lieu va ngiing hin vific sfl dung heroin: "Din khi dgt din lieu<br /> 30mg thi anh chl hit 2 Idnlngdy lhay vi 3 Idn nhu trudc, din 70 mg ihi anh<br /> chl ddng 1 man 1-2 lan heroin vd khi dgt 120 mg anh dd khdng con diing<br /> heroin nffa. Iff sau khoang 2 thdng san khi diing Methadone, anh khdng<br /> cdn ddng Igi heroin, anh bdt ddu ud'ng Methadone din gid dd ditac gdn I<br /> ndm " (Trich NKTD). TSl ca nhflng ngudi dugc tham gia vao chuong innh<br /> Methadone diu da trai qua rd't nhilu Idn cai nghifin khac nhau nhu tu cai<br /> bo a gia dinh, cai cd bac sy hd trg tai nha, cai d trung lam dfi'n vai chitc<br /> 136 Nghidn cflu Gia dinh vi Gldl. Quyd'n 22. s6'6, tr. 132-144<br /> <br /> Idn... hp cung da giam vk ngflng sfl dung trong mfll thdi gian, ft ihi mdt<br /> ludn, nhi(Su thi 2 nam nhflng kfi'l qua cud'i cung hg diu tai nghifin.<br /> Methadone cung gid'ng vdi cdc hinh thflc cai nghifin khac 1^ nhdm dfi<br /> ngudi nghifin tfl bd vific su dung heroin, nhung khac vdi nhung hinh ihtJc<br /> cai nghifin khac la khdng sfl dung heroin, cdn Methadone vdn phai sudung<br /> iiidi loai thud'c thay thfi'cho heroin nhung fi tdc hai hon heroin vd cd str<br /> kilm so;ii chat che vl mat y lO. Han nfla, cai bang Methadone, ngudi<br /> nghifin khdng phai trai qua nhung hdi chflng cai hfit sflc kho sd, vdt va mk<br /> vfl'n lii ndi am anh. so hai vk la mdt irong nhflng riio can ma ho khd vu