Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study
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BACKGROUND: Detention of people who use drugs into compulsory drug detention centres (CDDCs) is common throughout East and Southeast Asia. Evidence-based pharmacological therapies for treating substance use disorders, such as opioid agonist treatments with methadone, are generally unavailable in these settings. We used a unique opportunity where CDDCs coexisted with voluntary drug treatment centres (VTCs) providing methadone in Malaysia to compare the timing and occurrence of opioid relapse (measured using urine drug testing) in individuals transitioning from CDDCs versus methadone maintenance in VTCs. METHODS: We did a parallel, two-arm, prospective observational study of opioid-dependent individuals aged 18 years and older who were treated in Malaysia in the Klang Valley in two settings: CDDCs and VTCs. We used sequential sampling to recruit individuals. Assessed individuals in CDDCs were required to participate in services such as counselling sessions and manual labour. Assessed individuals in VTCs could voluntarily access many of the components available in CDDCs, in addition to methadone therapy. We undertook urinary drug tests and behavioural interviews to assess individuals at baseline and at 1, 3, 6, 9, and 12 months post-release. The primary outcome was time to opioid relapse post-release in the community confirmed by urinary drug testing in individuals who had undergone baseline interviewing and at least one urine drug test (our analytic sample). Relapse rates between the groups were compared using time-to-event methods. This study is registered at ClinicalTrials.gov (NCT02698098). FINDINGS: Between July 17, 2012, and August 21, 2014, we screened 168 CDDC attendees and 113 VTC inpatients; of these, 89 from CDDCs and 95 from VTCs were included in our analytic sample. The baseline characteristics of the two groups were similar. In unadjusted analyses, CDDC participants had significantly more rapid relapse to opioid use post-release compared with VTC participants (median time to relapse 31 days [IQR 26-32] vs 352 days [256-unestimable], log rank test, p<0·0001). VTC participants had an 84% (95% CI 75-90) decreased risk of opioid relapse after adjustment for control variables and inverse propensity of treatment weights. Time-varying effect modelling revealed the largest hazard ratio reduction, at 91% (95% CI 83-96), occurs during the first 50 days in the community. INTERPRETATION: Opioid-dependent individuals in CDDCs are significantly more likely to relapse to opioid use after release, and sooner, than those treated with evidence-based treatments such as methadone, suggesting that CDDCs have no role in the treatment of opioid-use disorders. FUNDING: The World Bank Group, Doris Duke Charitable Foundation, National Institute on Drug Abuse, Australian National Health & Medical Research Council, National Institute of Mental Health, and the University of Malaya-Malaysian Ministry of Higher Education High Impact Research Grant.
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Relapse rates for opioid use disorder continue to be above 50% at 6 months and similarly high worldwide.
“Relapse rates continue to be above 50% at 6 months (5, 6) and similarly high worldwide (7, 8).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [8]
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- Authors
- Wegman, M. P., Altice, F. L., Kaur, S., Rajandaran, V., Osornprasop, S., Wilson, D., Wilson, D. P., & Kamarulzaman, A.
- Affiliations
- University of Florida Health (US)
- Yale University (US)
- University of Malaya (MY)
- World Bank Group (US)
- Corresponding author
- Altice, Frederick L
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2017-02
- Volume
- 5
- Issue
- 2
- Pages
- e198-e207
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC5657487
- OpenAlex
- W2560590148
- Cited by
- 87
- References
- 35
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 7 · 2022: 7 · 2021: 10 · 2020: 22 · 2019: 14 · 2018: 6 · 2017: 7 · 2016: 1 · 2015: 1
- FWCI
- 9.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Bushehr University of Medical Sciences Repository (Bushehr University of Medical Sciences) (acceptedVersion)
- PubMed Central (acceptedVersion)
- The University of Malaya Research Repository (University of Malaya) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- World Bank, Malaysian Ministry of Education High Impact Research Grant (HIRGA E000001-20001)
- National Institute of Mental Health for career development (F30MH105153)
- National Institute on Drug Abuse for research (R01 DA025943 and R01 DA041271)
- career development (K24 DA017072)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- opioid use disorder, opioid relapse, methadone maintenance treatment, drug policy, drug users, urine drug testing, post-release outcomes, Malaysia, Klang Valley, addiction treatment, counseling, relapse risk factors, age at first drug use
- MeSH terms
- Adolescent, Adult, Analgesics, Opioid, Counseling, Humans, Malaysia, Methadone, Opioid-Related Disorders, Prospective Studies, Recurrence, Work, Substance Abuse Treatment Centers, Treatment Failure, Voluntary Programs, Mandatory Programs, Opiate Substitution Treatment
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