Factors associated with illicit injection drug use among methadone maintenance treatment patients in Indonesia

Despite methadone maintenance treatment (MMT), many continue injecting illicit drugs. In this study, we aimed to explore factors associated with continuing to use illicit injection drugs while receiving MMT in Indonesia in order to improve an illicit injection drug use harm reduction program for this marginalized population. We conducted this cross-sectional study among 342 randomly selected patients attending any of 11 MMT clinics in Indonesia, based on minimum sample size calculation and anticipated non-participation rate. Each subject was interviewed following a structured questionnaire and her/his MMT clinic records were also reviewed. Data were analyzed using multivariable logistic regression. A total of 266 MMT clinic patients participated in the study; 95.5% male. The median age of study subjects was 30 years; 38.3% of subjects (n=102) had a university education level; 87.2% (n=232) were employed, 49.6% (n=132) were married. Thirty-six point one percent of subjects (n=96) had injected illicit drugs during the previous month. On multivariable logistic regression analysis, factors significantly associated with injecting illicit drugs during the previous month were the subject perceived they had a more severe level of drug dependence [Adjusted odds ratio (Adjusted OR)] = 13.8; 95% confidence interval (95% CI: 6.6-29.0), subjects felt they did not have the ability to stop injecting illicit drugs (Adjusted OR = 5.4; 95%CI: 2.4-12.1) and the subjects felt they were in a high risk environment (Adjusted OR = 2.3; 95%CI: 1.2-4.5). Our study of MMT patients who inject illicit drugs during MMT shows this is a common problem in the study population, worse in those who believe their problem is more severe, they feel unable to stop or continue to be in a high risk environment. In order to improve MMT program efficiency, these problems need to be targeted and effective interventions created to improve them and then further studies need to be conducted to determine the efficacy of these interventions.