Opening: The Significance of the STAR-OM study

Associate Professor Dr. Le Minh Giang, MD, PhD emphasized that this is the first large-scale study in Vietnam to implement interventions aimed at reducing methamphetamine use among patients receiving methadone maintenance treatment, in the context of increasingly common concurrent use of heroin and meth. The STAR-OM study has demonstrated both the feasibility and effectiveness of Contingency Management (CM) and psychosocial therapies, showing noticeable reductions in meth and heroin use during at least the first 12 weeks. In addition, the ASSIST screening tool has shown potential to be as effective as urine testing, making it suitable for broader application in MMT clinics and primary healthcare settings.

Research overview and intervention effectiveness

In the opening presentation, Associate Professor Dr. Le Minh Giang provided an overview of the STAR-OM study and highlighted its key findings: high participation rates, dual effectiveness in reducing both methamphetamine and heroin use, and the potential to integrate interventions into the existing methadone maintenance treatment system. He emphasized that scaling up psychosocial interventions – particularly Contingency Management (CM) – is entirely feasible in Vietnam. He also recommended the use of screening tools such as ASSIST as an alternative to urine testing, noting their potential to reduce costs and improve overall effectiveness.

Patterns of methamphetamine use in methadone maintenance programs

Associate Professor Dr. Hoang Thi Hai Van and Dr. Nguyen Bich Diep analyzed the diverse patterns of methamphetamine use among methadone patients and their impact on treatment adherence. The study found that both the reasons for meth use (such as emotional relief or social interaction) and the form of use (crystal or pill) were closely linked to the risk of discontinuing methadone maintenance treatment. The speakers emphasized the importance of regular screening, behavioral classification, and the design of individualized interventions to improve treatment outcomes.

Economic Effectiveness of the Intervention

Dr. Nguyen Le Tuan Anh presented a health economic analysis showing that a 12-week CM intervention achieved higher response rates compared to a 6-week program, with only a modest increase in cost. However, among patients who did not respond to CM, adding the Matrix therapy provided only limited additional benefits. These findings suggest the need for flexible treatment planning, tailored to each patient’s level of response.

Opportunities and Challenges in Implementation

Dr. Nguyen Thu Trang shared experiences from implementing the STAR-OM intervention at MMT clinics. Both patients and healthcare staff reported that the intervention helped reduce methamphetamine use. However, several challenges remain, including workforce shortages, low healthcare staff salaries, and a legal framework that does not yet permit MMT clinics to intervene directly in methamphetamine use. These barriers highlight the need for policy support and adjustments in institutional roles to ensure sustainability when scaling up the model.

The panel discussion, chaired by Associate Professor Dr. Le Minh Giang, Professor Steve Shoptaw, and Professor Li Li, highlighted several key points:

• MMT clinics have the capacity to deliver psychosocial interventions, provided that staff receive adequate training and supervision.
• A combination of approaches (CM, Matrix, and future pharmacological options) is needed to achieve comprehensive effectiveness.
• Vietnam requires models tailored to its available resources and legal framework – ensuring effective treatment while remaining consistent with drug control regulations.

Representatives from MMT clinics and regulatory agencies also shared their perspectives on the impacts of recent changes to the drug control law, including concerns over declining patient numbers and funding constraints. Participants unanimously agreed on the need for standardized training materials that can be used not only by healthcare providers but also by community workers and police forces, thereby extending interventions to the grassroots level.

The workshop concluded with a commitment to further develop training materials and expand research on the STAR-OM intervention model. Evidence from the study confirms that reducing methamphetamine use within Vietnam’s methadone maintenance treatment system is entirely feasible – contributing to improved treatment quality, reducing the burden of synthetic drugs, and safeguarding public health in the context of rapidly evolving epidemiological trends.

On December 27, 2024, the Center for Research and Training on Substance Abuse and HIV (CREATA-H), Hanoi Medical University, SHP Clinic (Hanoi Medical University Hospital), and the WeCare Social Enterprise (SE) collaborated with Lighthouse SE Clinic to organize a training workshop titled “Screening, Brief Interventions, and Referral to Treatment for Substance Abuse.” This training targeted professionals currently working at Lighthouse SE Clinic. Participants in the training came from diverse professional backgrounds, including psychology, nursing, medicine, social work, and other related fields. These individuals brought extensive experience working in the PrEP program and engaging with various community groups. The workshop’s training team included notable experts such as Dr. Nguyễn Hữu Anh, a researcher in the Substance Abuse Specialist Group at CREATA-H, and Mr. Trần Văn Hưởng, a PrEP program counsellor at SHP Clinic. This initiative exemplifies the collaborative effort among stakeholders to enhance technical expertise and broaden the impact of the PrEP program, ultimately contributing to improved public health outcomes.

Trainees listening to the lecture on the process of SBIRT

During the training, the instructors shared in-depth knowledge on key topics, including: (a) Overview of addictive substances; (b) Stages of behavioral change and Motivational Interviewing; (c) Introduction to the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) toolkit; (d) Brief Intervention and Referral to Treatment (BIRT); and (e) SBIRT implementation procedure and experiences implementing at SHP clinic. In addition to theoretical content, the training featured practical activities such as scenario-based discussions and role-playing exercises. These activities enabled participants to not only understand the theoretical framework but also practice applying SBIRT procedures effectively.

Trainees participating in practical role-playing activities

The training concluded successfully, thanks to the active participation of the attendees. It provided an opportunity to share and discuss specialized knowledge, paving the way for the effective application of the SBIRT model in addressing substance use among clients participating in the PrEP program.

The training was led by experts with extensive experience in substance abuse treatment, including professionals from the Center for Training and Research on Substance Abuse – HIV, the Department of Labor, Invalids and Social Affairs, and the Hanoi Sub-department of Social Vices Prevention and Combat. The curriculum focused on equipping leaders with essential basic skills, ranging from the operational methods of the consulting points and the management mechanisms to the coordination and transfer of information, as well as the skills in counseling, supporting, caring for, and treating people who use drugs. During the training session, Dr. Han Dinh Hoe, PhD., a lecturer from the Hanoi Medical University and representative of the Vietnam International Technology Transfer Center (V-ITTC), shared his knowledge and instructed participants on effective communication, observation, questioning, listening, and client engagement skills.

In addition to acquiring knowledge from the lectures, trainees also engage in group practice sessions, have their questions answered, participate in discussions, and listen to the real-life experiences shared by both instructors and fellow trainees.

The training session was successful with active participation from officials in the fields of Labor, Invalids and Social Affairs, Public Security, and Healthcare. In the coming months, trainees will be part of the healthcare team directly applying the knowledge they have learned, conducting activities at the consulting points to care for and support clients, and treat drug addiction within the community.