China has made significant progress in implementing and enhancing MMT programs in the past five years. Tens of thousands of drug users and their families are benefiting from the positive outcomes associated with participation in MMT such as decreased drug use, criminality, and increased family relationships and employment (Sullivan & Wu, 2007
, Pang et al, 2007
). The communities have also profited from lower demand for local drug markets, reduced crime rates and improved local public security (Pang et al, 2007
). However, there are changes in clinic practices that could be made to increase the success of the program. Findings suggest the need to provide more support for the service providers, particularly in terms of ongoing training about MMT delivery and of salary support for providers. The relative effectiveness of the pharmacotherapy largely depends on the attitudes and services of those who deliver the treatment. Maintaining a stable workforce is an essential component for scaling up the MMT program and improving the quality of care for clients.
Good institutional support promotes a positive psychological state for service providers and prevents burnout and attrition in the workforce (Li et al, 2007b
; Ross, Greenfield, & Bennett, 1999
; Shoptaw et al, 2000
). In this study, the lack of institutional support was perceived by service providers as a barrier to carrying out their daily work and providing comprehensive services to clients. Inadequate financial support reduced service providers’ faith in the MMT program’s future, and their low salaries discouraged them from making long-term commitment to the MMT. China is not the only country faced by such problems. Kleber (2008)
reported that in the U.S., decreased funding for non-profit centres left many MMT programs inadequately staffed. In a qualitative study in Russia, service providers also identified lack of resources as a major challenge in service provision for drug using population (Bobrova, 2008
). It is incumbent on the government to ensure that resources are adequately and effectively allocated. Appropriate salaries for health care providers and supplies of working necessities can help to retain a trained workforce.
Because of the rapid implementation of the MMT program in China and the apparent lack of sufficient resources, the professional training for many MMT service providers was very limited. Any additional ongoing in-service training has been lacking. Training on behaviour interventions, psychological counselling, and health education was even more rare. Without the basic principal of harm reduction and necessary knowledge and skills, service providers inadequately prepared to affect clients’ motivation to change, personalized risk management, and mental health problems. Well-trained staff are key for effective methadone treatment (Ward, Hall, & Mattick, 1999
). This study suggested that more appropriate training, especially in the area of behavioural intervention and psychological counselling, is urgently needed by MMT service providers. A well-trained provider not only works more effectively in regards to prescribing appropriate treatment dosages and monitoring, but also interacts more positively with clients, which will, in turn, enhance relationships between the service providers and clients. In addition, training is desperately needed to help the staff feel competent to manage the security-related adverse events that occur in MMT clinics.
An alternate and perhaps concurrent approach to address these concerns is to professionalize service providers by creating an addiction medicine society that sets standards and guidelines for addiction treatment and promotes the appropriate role of service providers in the care of patients with addictions. In the U.S., the “American Society of Addiction Medicine” is an admirable model that provides guidelines for the implementation of addiction medicine and its providers (www.asam.org
). Service providers with increased knowledge and skills and with access to a medical society dedicated to treatment of addiction would likely feel more comfortable treating drug users. As well, it may be that when clinic administrators hire staff members who have previously worked in detoxification centres, the expertise in the MMT increases, which can aid all of the providers at the clinic in feeling safer and supported. Such expertise in mental health and addiction would also likely improve the clinics’ functions and working environments.
Drug use is in sharp conflict with the cultural and moral values of traditional Chinese society. The stigma associated with drug use and poor perceptions of MMT is prevalent in society (Deng et al, 2007
). Societal misunderstanding of MMT plays an important role in the negative feelings reported by the service providers. More education should be carried out to disseminate knowledge about the benefits of MMT to the general population and for policy-makers. Stigma reduction in society is essential to promote high-quality care for MMT clients by service providers.
The heavy work load and long working hour are sources of stress and burnout among service providers. There are strategies that could simplify working procedures and reduce service providers’ burden. For example, standardized electronic methadone prescriptions could be created to free the service providers from writing daily prescriptions. Service providers need assistance in carrying out other comprehensive services such as skills training and psychological counselling. Involvement of other institutions and incorporating their expertise into the MMT program would optimize resource allocation and achieve more favourable outcomes. For example, the labour department, community, and NGOs could provide skills training and employment for the MMT clients, and universities and mental health clinics could collaborate with MMT service providers to conduct group activities and individual counselling. These steps would reduce MMT service providers’ burdens and allow them to work more effectively.
There are some limitations in the study that should be noted. The data were collected from a region with moderate drug-use problems. Service providers and MMT programs in this area might differ from other parts of China. The sample was not representative of all service providers in the country. However, the fact that the average number of clients in the study clinics was comparable to the number in other clinics in the country may support the generalizability of the results. Even with these limitations, our findings identify essential elements for improving the effectiveness of MMT that should be carefully considered by policy-makers.
The study highlights major challenges faced by service providers working in MMT clinics in China. In conclusion, there is an urgent need to attract, train, and retain service providers to meet the challenges and needs of the rapidly expanding MMT program in China. It is essential that policy-makers and health administrators recognize and respond to the needs of the service provider workforce. The government should ensure that resources are effectively allocated in order to guarantee proper MMT clinic operation and that service providers are adequately compensated. Appropriate ongoing professional training should be given to service providers working in MMT clinics. We believed that as the MMT program expands and improves, more and more people and the society as a whole will be benefited.