Access to multi-day take-home methadone doses amid COVID-19 lockdowns

Minh (not his real name) grew up in Ho Chi Minh City as the only son in his family, being indulged. The beginning of his addiction went back to his teenage years. Under his peers’ influence, he started smoking heroin. As time went on, his obsession intensified, and the time of sobriety shortened. He spent his days deluging with the rush of euphoria by injecting heroin. 

Minh’s battle with addiction was a struggle for his family as well. Relying on his father’s earnings, his family maintained a rather good financial status. He kept turning to his family for money to meet his mounting demands for heroin doses. Finally, after all the futile attempts to help Minh out of the addiction, his parents gave up on him.

COVID19 raged across Viet Nam and deprived his father’s life in April 2021. Everything he had taken for granted collapsed. Not until that moment did he realize the responsibility of taking care of the family weighed on him. He voluntarily participated in the methadone maintenance therapy in a nearby clinic.

By June 2021, he regularly took a dose of methadone every day. He worked as a motorbike driver for Grab company, which provides ride-hailing and delivery services. The average income was around 200,000 VND- 300,000 VND per day. He earned 7million Vietnamese Dong for a month, which is quite a significant amount for him as a person who used drugs and relied on family for a living. Soon, as the lockdown rule tightened in July, transportation was dispensed, activities on the street were banned and Minh lost his job. He could barely go to the out-patient clinic to take the daily methadone doses, and not to mention to make a living. 

The strict social distancing rules enforcement created barriers to the patients to get their daily medication. The Ministry of Health quickly issued a letter to all provinces allowing for the implementation of multi-day take-home methadone doses as an emergency response to ensure continuity of access to HIV harm reduction in the context of COVID19 control measures. The initiative was immediately embraced by Ho Chi Minh City, the most severely impacted by the pandemic, with specific technical guidance from the Viet Nam Administration for HIV/AIDS Control (VAAC) under the Ministry of Health. 

As part of UN support for this initiative in Ho Chi Minh City, WHO and UNAIDS mobilized bottles of methadone for take-home doses until the end of October 2021. In cooperation with VNP+, UNAIDS also provided subsidies for the monthly fee (330,000 VND to 350,000 VND) to methadone patients most in need. The funding helped fill in the gaps of MMT commodity and lessen the financial barrier that may jeopardize people who use drugs adherence to methadone treatment. 

Through the multi-day take-home methadone doses program, many patients like Minh, who were on the pathway to recovery, could maintain access to the health services essential for their well-being. Methadone maintenance therapy (MMT) could decrease the injection of drugs and there to moderate HIV risk behaviors and increase access to HIV-related health services among people who use drugs. 

“Multi-day take-home methadone doses program and the subsidy of monthly methadone fee for clients most in need are timely compatible measure in response to COVID19 lockdowns.” Said Nguyen Anh Phong, representative of VNP+ in Ho Chi Minh City, “We as community workers have witnessed so many challenges faced by people living with HIV and key populations and their despair in the raging of COVID-19. We are thankful for agile HIV policy response and all the emergency support including from UNAIDS in the context of COVID-19**. We welcome to see differentiated HIV service delivery such as take-home methadone doses becoming a regular option.”

UNAIDS also joins efforts with UNODC and WHO to advocate for the institutionalization of a multi-day take-home methadone program in Viet Nam for people who use/inject drugs to receive their essential medication with minimized time cost, better medication adherence, and greater integration in social life. 

*VNP+: Vietnam Network of People living with HIV 

** UNAIDS has been providing emergency health/HIV/STIs and daily necessities support packages for people living with HIV and most affected by HIV in the context of COVID-19

Reference: 

UNAIDS (2017). Methadone. Access from: https://www.unaids.org/en/file/111118 

UNODC (2021). UNODC Supports Harm Reduction in Viet Nam Through Take-Home Methadone Doses. Access from https://www.unodc.org/unodc/en/frontpage/2021/February/unodc-supports-harm-reduction-in-viet-nam-through-take-home-methadone-doses.html