Abstract:
BACKGROUND : Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone
maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess
retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided
through a low-threshold service in Durban, South Africa.
METHODS : We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described
baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World
Health Organization’s Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life,
using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test
and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar’s test was used for comparisons between
paired results of categorical variables relating to injecting frequency.
RESULTS : The majority of the participants were young, Black African males, with a history of drug use spanning over
10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9
(p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite
score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254).
CONCLUSIONS : Interim findings suggest high retention, significant reductions in heroin use and improvements in
mental health among participants retained on methadone maintenance therapy for 6 months. Further research into
longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the
scale-up of methadone maintenance therapy in South Africa.
