Nghign cOfu Gla d i n h vk G i a i
sef 6 - 2 0 1 2
Trai nghiem cai nghien bdng Methadone:
Lai ich, Ihdch thuc va udc vgng
Nguyin Le Hoai Anh
TnrOng Dai tipc Sir pham Ha NOi
Trjnh Minh Phifdng, Le Mai Phi/dng
Trung ISm Nghifin cinj Phfit t n l n Y tg Cflng dfing
Nguyen Tien Dung
Tnjng ISm Nghifin cini vd Tir vdn Phat t n i n Cflng ddng Thing Long
Lung Bich Ngoc
Trung tfim Nghifin ciru v i OSo I90 HIV/AIDS. TniOig Dai hoc v HS Nfli
Tdm t&t: DUa tren dfl lieu dit'ii da dan tgc hoc ve giam hgi - Methadone do trUdng Dai hoc Y vk Trung tam nghien ciiu Phat tnen Y te cong dong (CCRD) thUc hien tai 2 qufin Le Chan va Ngo Quyen. thSnh pho Hai Phong nAm 2009, hki vi^t tim hieu nhflng trai nghiem cua nhflng ngUdi cai nghien trong qua trinh tham gia vko ChUdng trinh dieu trj Methadone dUdc trien khai tai Viet Nam nam 2008. Ket qua nghien ciiu cho th&'y m^c du con ton tai mot so' han che trong qua trinh dieu tri, nhUng nhflng ngUdi cai nghien bSng Methadone da the hi^n su hai long ve tinh trang sflc khoe to't hdn, ho cung gianh lai dUde niem tin cua gia dinh, ban b6, cong dong vk c6 nhieu hy vong vao viee tfl bo dUdc ma tuy, Nghien cflu nay cho r&ng de Chuong trinh Methadone dat hieu qua, c^n coi trong quyen tU quyet cua ngUdi dieu tri Methadone va giai quye't dUdc nhflng kho khSn, thaeh thfle nay sinh trong qua trinh cai nghien b&ng Methadone.
Tif k h o a : Methadone; Dieu tri Methadone; Ma tuy; HIV/AIDS.
N g u y e n I,r Hoai A n h va c a c t a c gia 1 33 1. Md dau
Tai Viet Nam, dich HIV/AIDS van tap trung chii yfi'u trong m6t s6 nhom hanh vi nguy ca cao irong do nhom nghien chich ma luy ehifi'm chu y^u vdi ty le nhifim HIV Ik 28,61% (Nguyen Van Kinh, 2004:9). Tfl nam 1998. chfnh phii da c6 cac van ban luat. chinh sach, trong do cai nghien ma tuy cho nhom nghifin la mni trong nhung trpng tam. nham ung phd v6i cac dai dich HIV. Chuong trinh hanh dflng qu6'c gia vfi HIV nam 2010 va ldm nhin 2020 bao g6m 9 chucmg trinh hanh dflng, trong do chuong trinh hanh dflng sfl' 2 tap trung vao cac hoat dflng can thifip giam hai trong lay nhifim HIV. Bfin canh cac chuong hinh giam hai nhu phat bcfm kim tifim mifin phi da dugc ap dung ttr trudc, Vifit Nam da budc ddu dua vao su dung thii nghifim cha't cai nghifin thay thfi' Methadone. Dugc sij" dung Idn ddu tifin tai My vdi muc dich cai nghifin, hifin nay. Methadone da dugc sfl dung rflng rai tai nhi^u qufl'e gia trfin ihfi' gidi. Tai Viet Nam, Chuong trinh Methadone dugc trifi'n khai ddu tifin lai Hai Phong vao thang 4 nam 2008 va lai thanh phd H6 Chi Mmh vao thdng 5 nam 2008.
Cho tdi nay, cd kha nhi^u chucfng trinh danh gia hifiu qua cac Chucmg trinh cai nghifin bang cha't thay thfi' Methadone sau mflt thM gian thfl nghifim. Tuy nhifin, con kha ft cac nghifin ciru danh gia chuong trinh dieu trj Methadone tfl goc dfl ctia ngudi dieu tri Methadone. Bai vifi't nay tap trung phan tfch nhiJng trai nghifim ctia ngudi cai nghifin trong sufl't qua trinh dilu tri va ttr nhiing Irai nghifim ctia nhflng ngudi "trong cudc", mong mud'n nham gdp p h ^ cai thifin cac chuong trinh dieu tri Methadone trong thdi gian tdi khi chuong trinh nay dang cd ke'hoach nhan rflng ra toan bfl cac tinh Ihanh khac irong ca nudc. Nghifin cflu nham tra Idi hai cau hdi sau: i) Trai nghiem cua ngudi di^u tri Methadone? ii) Nhirng ngudi difiu tri Methadone gap nhiing Ihach thuc nhu thfi' nao trong qua trinh thuc hifin?
2. Phuong phap
Vdi sir cho phep ctia STAR, nghifin ciiu cua chung ifli sfl dung du Ueu Ifl nghifin ciru di^n da dan tflc hoc vi giam hai - Methadone do u-udng Dai hgc Y va CCRD ihirc hifin lai quan Le Chan va quan Ngd Quyen, thanh phfl' Hai Phong tfl thang 2 de'n thang 9 nam 2009. Ddi lugng nghifin cflu la ngudi di^u tri Methadone; gia dinh ngudi su dung Methadone va ngudi su dung heroin dugc luyfi'n chon khi cac nghien cuu vien diln da lai cac phong kham, cac quan nudc xung quanh co sd dilu trj, cac diem nong vl ma tfly va qua gidi Ihifiu.
1 34 NghiSn cUu Gla dinh v4 Gldl. QuyS'n 22, so 6, tr. 132-144
Du lifiu g^^m 33 giai bang phdng va'n sau va 13 nhat k^ thirc dia. cu Ih^
nhu sau: I'hdng vfl'n Ijch sfl ddi sfl'ng: 3 iSn vdi 9 ngudi difiu tri Methadone (tnii nghifim cai nghifin lai cac trung tam cai nghifin \ii chudng trinh Methadone) \;i 2 Idn vdi 2 ngudi nghifin ma tfly (irai nghifim cai nghifin lai cac trung tam). 6 phdng va'n sau vdi gia dinh ngudi su dung Methadone va 13 nhai ky thirc dia (NKTD) cua 2 nghiCn cflu vifin lai phdng khdm quan 1 ,c C 'han va 1 nghifin cflu vifin tai phdng kham quan Ngd Quy^n, vdi nhflng quan sal, ciim nhan. suy nghT rifing cua nha nghifin cflu vi nhflng hoat dflng difin ra lai cd sd dicu iri. nhung cau chuyfin ngoai quan nudc;
nhung trao drfi v^ Methadone, nhung md'i quan hfi xa hdi. thai dd, hanh vi cua ngudi then trj.
3. Ket qu^
3.1. Quy Irinh tham gia MIO chmmR trmh dieu tri M t l h a d o n e Hdu hot ngudi tham gia difiu tri NktlLklnne dfiu fl-ong dd ludi tfl 30-40 ludi v^ cd thdi gian nghifin ma luy nhifiu nam. Nam chi^m da s6. hdu hfi'l chua cd gia dinh vk khdng cd vific lam. Cdc thdng lin m^ nguM di^u tri Methadone lifi'p nhan diu khdng "chi'nh thflc", ma chii yfi'u thdng qua thanh vifin gia dinh, ban be, can bd y le (quen biS'l \(S gia dinh) \ on la nhirng ngucri nhan duac thdng tin qua cac md'i quan hfi \a hdi cua ban ihSn ho. Chinh vi
\ay. cac Ihdng tin m^ nhung ngudi nghifin ma niy nhan dugc 1^ chira d:i\ dii va thifi'u chfnh xac, tuy nhifin cac ihdng lin nky cung giup hp bifit vl Methadone, lac dung chi'nh, tdc dung phu va hifiu qua da dugc bifi't dfi'n.
Nhiing thflng tin nay lao cho ngudi nghicii ihfini tin tudng, dac bifit la dd'i vdi nhung ngucri nhan ihdng tin tfl ban be nghifin da sfl dung Methadone dfi' ifl dd cam tha'y yfin tam, mong mud'n iham gia vao chucmg trinh.
Dfi tham gia vao chuong trinh dilu tri Methadone, ngucri nghifin cdn phai dap ung dugc mdt sfl' lifiu chf nha'l dinh gdm cd: ludi tfl 18 ird Ifin, dd'i vdi ngudi tfl 16-18 ludi phai cd ngudi giam hd hgp phap ciia ngudi dd tu nguyfin va cam kfi'l bang van ban \c man ihii dilu tri nghifin cac cac dang Ihuflc phien (CDTP) bang thud'c Methadone, khdng cd hknh vi vi pham phap luat, du sflc khde, khdng mac bfinh man tfnh. Bfin canh cac lieu chi chung, cac dd'i tugng sc dugc uu tifin tham gia chuong trinh nfi'u dap ung dugc cac lifiu chf rifing nhu sfl dung cha't dang ihud'c phifin bang dudng tifim ehi'ch, nghifin ft nha'l 3 nam, cai bang nhilu Mn nhung vdn tai nghifin.
Ngudi dilu tri Methadone dugc quyfi'l dinh chi'nh trong vific tham gia dilu tri tai trung tam. Tuy nhifin, ngudi nha, dac bifit la ngudi me, lai chi'nh la ngudi tham gia vific hoan ihifin hd so dang ky tham gia chuong irinh.
Nguyen Le Hoai Anh va cac tac gia 135 Cac thii tue dang ky tham gia gdm cd xdc nhan cua phudng, tram y l^, don cam kfi't cua gia dinh. den lu nguyfin tham gia chuong irinh. Da sd nhan xei thdi gian xet duyfil hd sd dai va kfio dai khoang 1-2 thdng trudc khi ngudi nghifin dugc ggi Ifin phong va'n di quyfi't dinh tham gia chuong trinh.
Dilu nay khifi'n cho ngudi tham gia cam tha'y chdn nan. "Ldu ldm. em cdm tudng phdi de'n 2- 3 thdng gi day. Em cdm tudng thdi gian di ldu, me em ddng ki. ddng ki Idu ldm rc'ii the nliiOig vdo gap bao nhiiu Idn md khdng dirge. Ngciy ndo cung di. md ngdy ndo hai me con cffng dien thogi rio rdt the md cffng khdng ditcrc. Em nghi Idm sao md thudc ndy khd khdn din mitc do vdo khd thi... Cir thi Idm liic em nglu em cffng ndn thdl nhung em khdng ddm noi ra vi str ndi ra anh d'y ccm ndn qud" (Vo ngudi dilu trj Methadone).
3.2. Trai nghiem ctia ngudi nghien ve nhCrng Igi ich ciia Chucmg trinh Methadone
Cam \uc phd bifi'n nha't ma da so nhflng ngudi tham gia chuong trinh dieu tri Methadone trai qua dd chi'nh \k hg cam tha'y Methadone da cd nhung tac ddng. anh hudng ra'l Idn tdi cudc sdng ciia hg "Anh cd ndi, thitc ra theo quan diem ciia da sd nhffng ngitdi a ddy nhu anh thi anh thdy methadone cd lac dgng rdt Idn din cudc ddi nhffng ngitdi nhu cdc anh "
(Tn'ch NKTD). Mdt sfl' ngudi cho bifi't su thay ddi cua ban than khi duac chap nhan cho dieu tri Methadone dugc vf nhu "budc vao cudc sd'ng mdi"
va "lhay ddi hoan toan" (Trfch NKTD).
Thay doi bdn thdn vd md'i quan hi vdi gia dinh
Trai nghifim rd rang nhat, dilu khifi'n ngudi dilu tri Methadone cam th^y hai long nha't la Methadone da tao ra ihay ddi, dem lai Igi fch cho chi'nh ban than va gia dinh hg. Trudc hfi't, ngudi nghien da giam va ngimg sudung heroin mgt each tfl tfl, nhe nhang, khdng phai trai qua Irang thai vat va cua hdi chflng cai. Vdi nhung ngudi mdi bat ddu dilu tri Methadone thi hg vdn sfl dung dong thdi heroin. Tuy nhien chi sau thdi gian ngdn hg da giam lieu va ngiing hin vific sfl dung heroin: "Din khi dgt din lieu 30mg thi anh chl hit 2 Idnlngdy lhay vi 3 Idn nhu trudc, din 70 mg ihi anh chl ddng 1 man 1-2 lan heroin vd khi dgt 120 mg anh dd khdng con diing heroin nffa. Iff sau khoang 2 thdng san khi diing Methadone, anh khdng cdn ddng Igi heroin, anh bdt ddu ud'ng Methadone din gid dd ditac gdn I ndm " (Trich NKTD). TSl ca nhflng ngudi dugc tham gia vao chuong innh Methadone diu da trai qua rd't nhilu Idn cai nghifin khac nhau nhu tu cai bo a gia dinh, cai cd bac sy hd trg tai nha, cai d trung lam dfi'n vai chitc
136 Nghidn cflu Gia dinh vi Gldl. Quyd'n 22. s6'6, tr. 132-144
Idn... hp cung da giam vk ngflng sfl dung trong mfll thdi gian, ft ihi mdt ludn, nhi(Su thi 2 nam nhflng kfi'l qua cud'i cung hg diu tai nghifin.
Methadone cung gid'ng vdi cdc hinh thflc cai nghifin khac 1^ nhdm dfi ngudi nghifin tfl bd vific su dung heroin, nhung khac vdi nhung hinh ihtJc cai nghifin khac la khdng sfl dung heroin, cdn Methadone vdn phai sudung iiidi loai thud'c thay thfi'cho heroin nhung fi tdc hai hon heroin vd cd str kilm so;ii chat che vl mat y lO. Han nfla, cai bang Methadone, ngudi nghifin khdng phai trai qua nhung hdi chflng cai hfit sflc kho sd, vdt va mk vfl'n lii ndi am anh. so hai vk la mdt irong nhflng riio can ma ho khd vu<Jt qua. Va (i;ii nghifim dau tifin ciia hg di) la cam thify thoai mai va yfin ldm, hy vgng vko khii ndng ho cd ihl cai nghifin thdnh cdng.
Thfl hai, vdi nhihig ngudl tifim chich ma luy. diing Methadone da giup hg giam nguy co Idy nhidm I IIV- mdi hifim hpa nhan liln md ai cung bifi'l.
Vd cung nhd dd hp cd thfi' giam nguy co tfl vong do tifim chich qua lilu, bdi lieu lupng Ihud'c Methadone dupe su dung tuy ihudc vdo dac difim rifing cua mdi ngudi tham gia difiu iri, ddng thfiri cdn c6 su tu vfin, kham va kifim tra cua bac sy phdng khdm dl dam bao su chudn xac trong tflng lilu thudc.
Thfl ba, dicu khifin ngudi dilu m Methadone cam thdy vui ve, phdn khdi dd Id tinh trang sflc khde cua hp duoc cai ihifin hem irudc: "dug ndo chai heroin vdo bao gid nguiri ke cd co bio thi cung xanh xao, anh ndi thdng thi. Khi khc'mg dung nffa rdi thi bao gid nguiri cilng hdng hdo, bio lin; cdi lliff nhd't la khoe hcfn khi dung heroin td cdi chac chdn; cdi thff hai vi ndi tgng cung nhu ddu dc nd .se khdng hgi bdng khi diing hercrin; cdn ndng thi khdng ndng bdng heroin, anh not thdng heroin ndng htm nhieu"
(Ngudi dilu tri Methadone).
Nhu vfly, so vdi td't ca nhung Idn cai nghifin da tung trai qua. 1 ^ nay vdi Methadone, ngudi nghifin nhdn tha'y cudc sdng cua minh da lhay ddi li'ch cixc han trudc rai nhilu. Mdt Igi ich rd'l ldm ddi vdi ngudi nghifin khi tham gia Chucmg trinh Methadone la hg khdng phai lo kifi'm lien phuc vu vific ehi'ch hut nhu uudc nfla. Hp cd nhilu thdi gian hem cho cham sde ban than minh. Do vdy nhung ngudi da dilu tri 6n dinh co ddc difi'm khac bifit so vdi ngudi mdi dilu tri chinh la tinh trang ve sinh td'l hon, cd thdi gian cham soc CO thi nfin trflng hp khoe manh, sach se va chin chu hon: 'Trudc ddy mdi ngdy 4 bffa chich, sau bffa irifdc di tim liin di chich bffa sau cd ngdy chl ludn qudn vdi nic kiim mdi chich, bd't kimita gid bao biine cha chi't me chit cung vdn phdi di. Gid cugc sdng thanh thdn vi thitc ra trudc ddy ngdy phdi Ion mgi vdi trdm (nghin) cho Irich ihi gid chdng tieu tdn ddng ndo, chl cd tiiu cho nhffng nhu cau hit site ca bdn md khdng phdi lo
N g u y e n Lc Hoai A n h va c a c t a c gia 137
chi, vd lai minh cdn dang trcmg thdi ky dieu tri. nguiri thdn dgng vien vd cUng khdng phdi lo Idng gi ve tien hgc " (Tn'ch NKTD).
Bfin canh dd nhilu ngudi dilu tri Methadone cdn cho bifi't hp cd dugc tinh thdn thoai mai, thanh than, nhe nhdng, vui ve, su tu tin va cam nhan dugc su tdn trgng tfl nhung ngudi xung quanh - mflt trai nghifim rd'l tfch cue ma nhung Idn cai nghifin trudc dd khdng c6 dupe: "Din kin vdo dugc Chuong trinh Methadone ndv thi mdi tim Igi duac chinh minh nhu hdi xica" (Ngudi dieu tri Methadone). "Hgcdm thd'y duac mgi ngudi ton tigng ggi bang anh em, dUcrc khuyen nhu Idm sir khi mde ten ldm, diiu md trudc ddy hg chl cd nhdn duac tff bd me anh em khi mdi nghien, d cdi thdi md hg khong dirt ra dugc vdi ma tiiy i di ddn cffng chdng ai thim quan tdm nffa" (Trfch NKTD) Ho cdn tu nhdn minh cung thudn tfnh hon, ma ly do cho su thay ddi nay dd Id: "Cdi thff nhd't Id, trudc ddy minh din thi minh tumgc cdm trong ngudi. Minh din chi cd mdt Id xin lien, hai Id vay tiin, ba Id lay do dgc ciia gia dinh. bdn Id mUgn diu dd dgc cua gia dinh. Thi nhimg bdy gid minh din, nhffng thff dd minh khdng cdn, thgm chi di anh cho tiin, anh khong Id'y Trifcxc chUa cdn cho anh dd xin roi, de ra id anh lay rdi. Bdy gid din thi di bdo cho mdy may chuc mdy clri tiiu cung khdng lay, khdng cdn gi de'n tien nffa thi tit nhiin minh cdm thd'y tu tin ngay. Vd khi ngudl ta thd'y nhu thi tin minh din thi ngudi ta dd'i xir vdi minh khde ngay, do lin cdy co" (Ngudi dilu tri Methadone).
Nhu vay, so vdi vific cai nghifin lai cdc trung tdm, trai nghiem cua nhflng ngudi tham gia dieu Iri Methadone dd Id hp cam thay tu do va chu dpng han rat nhieu, vi hg chi'nh la ngudi tu quyfi'l dinh qua trinh dieu tri cua minh. Hang ngay, hg chi dfi'n trung tdm dfi la'y ud'ng thud'c mdt lan vao gid hdnh chfnh, hp dugc Iham gia cac sinh hoat binh thudng cua cudc sd'ng hang ngay chfl khdng bi each ly hoan loan vdi mfli irudng bfin ngoai. Thay vi phai tham gia dieu tri cai nghien bat buflc vdi thdi gian tdi da la 2,5 ndm Irong tmng ldm, hg cd thi tu nguyen dang k^ tham gia dieu tri, tu chu vific dieu trj va quye't djnh thdi gian dtmg dilu tri cua minh. Dilu nay lam tdng them sir tu tin cho chfnh ban thdn hg.
Thfim vao dd, vific dilu tri Methadone cdn giup cho nhung ngudi nghifin cd th^ lam nhung vific ma trfldc dd khi nghifin da khdng the lam, hp cd the de'n nhflng ndi ma irudc dd khi cdn nghifin hg khdng hi dfi'n nhu choi nha hp hang, dfi'n nhihig noi vui chdi giai irf, chai the thao,v.v. "Trffdc anh sff dung anh khdng bao gid budc chdn din nhd di anh, kin di anh biit rdi ihi anh din duac, thdm chi vay lien di cilng cho vay, trudc khdng bao gid cd " (Ngudi dieu tri Methadone). "Minh cung din nhung nai vui chai,
138 Nghidn cflu Gla dinh vd Gldl. Quydn 22, sd'6, tr 132-144
di ndng vd phe hndi tc'ri... nhffng lufi dd trUc'rc ddv minh khdng din. Ban ngdy minh cd thi din chu nhd ngttcYi thdn qiien, dUe/c chdo ddn, dutfc tiip (liuven vd minh i ung thd'y viic de'n chcri Id cdn iliiit. iruc'fc ddy minh khdng ddm deu iihn'iig gid minh din vi thdy nd hit .sffc tliodi mdi. Cdn mfit dieu nffa Id minh cdn the due the ihao. It uc'k da\ liic nghien khc'mg hdn Id minh khc'mg mudn ldp hay khdng cd tlidfi gian tgp. md Id minh giff khdng cho ra md he'd" (Ngudi dilu tri Methadone).
(iid giilc sinh hoai cua ngudi dilu in Methadone da dn dinh hdn chfl khdng cdn thai IhircVng nhu trudc. Do vdy, hg cd thdi gian dfi ddng gdp Ihfim cho kinh tfi ciia gia dinh - dilu ma trudc (Ki\ khi nghifin ma tfly hp khong thi Idm dirge. '"Tiuirc duv nhd anh ticmg \e dgp. chua benh. cnih klu'mg bao gidlc'im viic dd. ihiiihimg Inivgidanh cd thi trong xe dgp. anh CO the chffa binh ci'ing gia diiili dugc. ddy Id cdi thir nhd't. Thff hai. tiitdc day anh khc'mg di Idm, loim lay liin cita gia cVtnh thdi. thi bdy gid anh di ldm. cung cdm lien vc ddng gdp cho gia dinh. Ddy la nhffng cdi minh ldm J(/v/c" (Ngudi tiicu tri Methadone).
Dd Id nhutig irai nghifim hei sflc vui ve cua nhiing ngudi tham gia Chuong trinh Methadone trong 9 thang ddu difiu iri. Nhimg khdng chi dimg lai d dd, nhd vdo vice tham gia Chuong Irinh Methadone, ho con cai thifin mfl'i quan hfi vdi gia dinh va cflng doiig xung quanh.
Cdi Ihien mdi quan hi vdi gia dinh \d cgng ddng
Dieu ma td't ca nhflng ngudi tham gia Chucmg trinh Methadone deu nhdn thd'y. du la mdi dilu ui hay da dicu tri fln dinh chi'nh la ho dJ lay lai dugc nifim tin cua gia dinh, ban be, ngudi thdn, hang xdm Idng gilng va vdi ca vdi chi'nh quyin dia phucmg - dilu ma trudc day khi nghien heroin la qua "xa xi" dd'i vdi hp.
Trudc hfi'l Id c;ii thifin rdt td't mfl'i quan hfi trong gia dinh: "Gia dinh thi tnrdc ddy bdo la dua tiin cho minh Idm cdi gi dd ihi khdng bao gidcd. Cdi thff nhd't Id tiin mua \e. ddng tiin dien. tiin nudc md dua cho minh cdm thi khdng bao gidcd. Nhioig md bdy gid thi minh cd thi cdm tiin dien. tiin nUdc minh ddng, xe phdo thi minh mua. minh cd themuan xe a nhd, muon dugc" (Ngudi dilu tri Methadone). Nfi'u vdi nhung ngudi binh ihudng thi day la vific ldm ihfldng, nhung dfl'i vdi ngudi nghifin thi day la mflt "thanh tfch Idn lao" ma hg cd dugc nilm tin cua gia dinh. Hp cam thd'y vui ve hanh phuc, lir hao vl minh hem: "Bdy gid minh thd'y cugc sdng di chiu gia dinh vui ve han, quan tdm chdm soc nhau han. Trudc ddy khi minh nghien minh hay can bdn, gid minh ndng chdo hdi hdi thdm mgi ngifdi, ve nhd lidi
N g u y e n Lo Hoai A n h va c a c t a c gia 139
borne nin bd me vui, be') me dd'i vdi minh cung ilii. trudc con nghien thi minh mudn di ddu, mud'n ngii din bao gid c ung ki. khong dn thi then. Gid din gid dn ccfm nin me thd'y minh ngii thi (img nlulc dn ccrm ciing cho diing gid, site khde minh Hit hem " (Ngudi dilu tri Methadone).
Ngudi nghifin tiiudng khdng cd mfl'i quan hfi tfl't vdi hang xdm, Idng gilng bdi hg ludn bi ky thi, bi phdn bifii dd'i \u, Nhilu ngudi hdng xdm khflng lin vdo vific cai nghifin vi da cd qud nhilu nhung irudng hgp tai nghifin xung quanh hg. Tuy nhifin, nhihig ngudi cai nghifin bdng Methadone da cho bifi't nhung thay ddi rd rfit trong md'i quan hfi ciia hp vdi nhiing ngudi hang xdm.- "Minh thiiu tiin tin cd thi vay dUc/c; cdi thff hai, minh di i a ndng nUck', dn qud md cjuen khdng cdm liin thi li nffa minh ra trd thi ngud'i ta vdn vui, nhimg md trudc, ne'u nhu thi Id ngudi la nhdn mat lai, ngitcri ta nglu minh ldm gi cd tiin. Hdng .xt'mi Idng giing khdng xa Idnh minh nhu trudc. Iritdc ddy niu minh no diia vdi cdc em nhd quanh xdm thi borne chung khong hdi long, cdn bdy gid minh thd'y khdng cd viic dd nffa, hg cffng chil dgng hdi chuyen nhu Id minh chua bao gid nghien " (Ngudi dilu trj Methadone).
Mfl'i quan hfi ban be cua nhflng ngudi cai bang Methadone da cai thifin hon rat nhilu, hg nd'i lai spi day tinh cam, Id'y iai nilm tin cua nhung ngudi ban khflng phai "cung hdi cung thuyin": "Bgn be khi biit minh diaig heroin vd udng cdi ddv thi nd din rii di chcri, quan he nd khong nggi nffa "
Tfl khi dung Methadone thi hp cd nhieu thdi gian hon dfi' suy nghi vl mgi vific, cd nhu cau chia se tmh thdn vd gdn gui hon vdi ban be cu:
"Ngudi bgn md D co thi chia se nhiiu diiu, ciing cd hodn canh dimg Methadone nin cffng cd nhffng diiu suy ngliT gdn gui cd thi chia se dugc vdi nhau " (Tn'ch NKTD) vd dong thdi vdi nhflng ngudi cung tham gia tai cac nhdm dieu tri cung thanh lap nhdm tu luc d l cung nhau chia .se, ddng vifin, khi'ch lfi nhau duy tri vific dilu tri Methadone: "Thdnh lap di giiip dd nhau VU0 qua, vi du nhu Id ai cdn chai day. thi giiip dd nhau, cho ngudi ta thdi. Cdi thff hai Id trong nhom day thi nhd ai dm dau, ma chay gi thi ciing din. dm thi din, ihdng dong mdi ngudi md'y nghin vdo day, din ma chay thdm hdi, cudi xin thi chia vui, nhdm tu tap vdo. Nhffng ngdy li, ngdy lit thi tap trung vdo di choi, cdn nhffng ngdy thudng tin tap trung vdo dn ud'ng, lien hoan vdi nhau " (Ngudi dilu tri Methadone). Nhdm ban be la yeu tfl' quan trpng vdi nhflng ngudi nghifin. Trong nhieu irudng hgp tfl chi'nh mang ludi ban be ndy ma hg da sa vdo con dudng nghifin ngdp roi lai nghifin; nhung cung chi'nh tfl mang ludi ban be da giup hg hda nhap xa hfli vd Ihl hifin su gdn kfi'l khi hp ciing nhau iham gia chuong trinh dilu tri
140 Nghidn cflu Gla dinh vd Gldl. Quy^n 22, sd'6, tr. 132-144
Methadone, cflng ddng vifin khuyfi'n khi'ch nhau duy tri, thuc hifin nghifim chinh quy irlnh dilu irj d l cung hy vgng cd ihl tfl bd dupe ma tfly.
Dac biOl, mdi quan hfi cua nhflng ngudi tham gla Chuong trinh Methadone vdi chfnh quyfin tha phuong cung cd sir chuyin bifi'n li'ch cue:
"Chinh quyen ngii'di ta hiit ngUcri ta cffng tdn trgng minh han. Phifdng nguiri la cung vdo dong viin Id cc')'gdng" (Ngudi dicu tri Methadone).
Chinh vi td'l cii nhfllig thay ddi Idn lao trfin do Methadone mang lai cho chfnh ban th;tn ngtrdi nghifin, hp da itr tin hem v.i thdm chi cd ngudi sau thdi gian ud'ng Methadone d.i tfnh tdi vific dimg han \ific dilu iri. cai nghifin hodn todn: "Tff ddu nam 2009 anh dd xin gnini lieu divu iri deddn I iit khdi chitcmg li inh. qua 3 thdng anh dd gidm tiiu lif I20mg xiifi'ng 90mg vd anh llid'v minh vdn id't. khdng dung hu heicrin vd khc'mg cd cdm gidc Ihem Anh dang linh gid den cud'i ndm se gidm liiu ddn vd mong mud'n hit ndm 2009 sedgl difc/c muc dich gidm liiu vd xin ra khdi chitcmg Irinh diiu tn methadone cud'i ndm nay" (Trfch XK'ID) Tfl dd nhiing ngudi cai nghifin mong mud'n xdy dung lai cudc sd'ng, mong mud'n dugc lam vific va mong ed hanh phuc gia dinh nhu bao nhung ngudi binh thudng khac: "Gid anh cd thi tif tin kin gap bgn he. gia dinh vd be bgn diu mifng. bd con xdm pho Cling mimg cho bdn than anh vd lufin dgng vien khich li anh edgdng cai nghien di ldm hi, di tim mdt cfing viic phii hap sau ndy" lSs.\iai difiu tri Methadone).
Cud'i cung, dd'i vdi cdng ddng, \;i hdi, Chucmg irinh .Methadone da giup ldm giam cdc hanh vi tfli pham. Khi nghifin heroin, hp phai tim mgi edch de cd tiln chfch hiit. cho dii lay cua gia dinh. trdm cdp vat cua hang xdm hay ed nhung hdnh vi cudp gidi, budn ban van chuyfin heroin... thi nay vdi vific dicu tri methadone, hp khdng cdn phai lo idi \ lec kifi'm liln cho nhung cdng vific dd nfla. Do vdy nhflng nguy co pham phdp giam hdn. Htm nua, hieu qua kinh tfi' cua dilu trj Methadone da dugc nhilu nudc nghifin cflu va dua ra kfi'l ludn: "1 USD chi cho Chuong u-inh Methadone se tifi't kifim dugc 7 USD chi cho cae vd'n dl khde phdt sinh nhu cdc ve vd'n d l phap ludt y tfi''' (Doan Hflu Bay, 2012).
Nhu vdy. qua trai nghifim trong mpt thdi gian ngdn, a giai doan ddu tifin eua qua irlnh dilu tri Methadone, nhflng ngudi tham gia chuong trinh nay da thi hifin thdi dp khd hai long vdi nhflng thay ddi md Methadone dem lai cho ban than hp va gia dinh, giup hg dugc ihl hifin su lu tin vdo ban than va hy vpng cai nghifin thdnh cflng.
Nguyen L6 Hoai Anh va cac tac gia 141 3.3. Trai nghiem ve nhCimg khd khdn, thaeh thdfc cua chuimg Irinh dieu tri Methadone
Su ky thi ciia cgng ddng
Su ky thi tfl phi'a cdng ddng vdn Id dilu ma khflng ft nhung ngudi cai nghifin cd thi vupt qua dupe. Vd'n dl thudng gdp nhd't Id hdng xdm cho rdng hg Id nhirng ngudi gdy ra cdc vu irdm cdp trong cflng ddng. su ky thi nay manh me dfi'n mfle mde du cd nhung ngudi khflng hi trflm cdp nhung cung eho rdng hang xdm nghT nhu vdy Id ed ly. "Udm ndo xdm md't cdi gi, md minh cffdi ra di vdo Id nguiri la cir nhin minh... ihUc ra bdn thdn minh CO lite nhioig minh phdi chdp nhdn thdi vi minh nghien minh khdng ddm ndi ra" fNgudi dilu tri Methadone). Chinh vi vdy nfin ban ihdn hg cam thd'y xa'u hd, nhilu khi tu va'n, hfl'i hdn vdd qud khfl, va ngay ca khi dang dugc dilu tri bdng Methadone hg vdn mang theo mde cam, tu ti trudc ddy
"Vi du minh dang Idm xe cd ngitcri di qua, khong phdi ngUdi la noi minh md ndi nhffng Irifdng hap khde. minh dioig day cilng khd tdm ldm... "
(Ngudi dilu tri Methadone),
Mac dfl phdn Idn ngudi dugc phdng vd'n cho rang hg dugc tu va'n, dugc dfli xfl binh ding, than ihifin, dilu nay duge hg danh gia cao vi uudc day fig Ihudng bj gpi la "eon nghien". Nhung bfin canh do mpt sd ngudi cdn cho rdng hp vdn gap phai su ky thj tfl mpt sd nhan vien d eo sd dilu tri, dilu nay eung gay trd ngai dfi'n tam ly eua ngudi dilu tri Methadone
Tdc dung phu cua Methadone
VI mat dugc ddng hoc Methadone la mpt chd't ddng vdn cua cac chd't dang thuflc phifin nhu thud'c phifin, morphin, heroin... mac du cd lac dung dugc ly tuong tu, mdt trong nhung khac bifit co ban so vdi cac chat dang thud'c phien la khdng gay nhifim ddc hfi thdn kinh trung uong. tuy nhifin ngudi duge dilu tri lai bj khd chiu do nhflng tac dung phu cua Methadone gay ra (Bd Y lfi', 2010). Cac phien phflc dupe kl din nhilu la budn ngii, vd cac rdi loan dudng lifiu hda. Con budn ngu dp dfi'n khi nao hg khflng lam chu dugc, khifi'n hp nhin bl ngoai lim dim nhu dang phe thufl'e dilu ndy cung khifi'n ngudi khac ed thi ddnh gia thd'p hifiu qua ciia viec dilu tri vl cho rdng nhung ngudi ndy vdn ngua quen dudng cu. Budn ngu cung gdy ra eac phien phflc khae nhu anh hudng dfi'n cdng vifie ehdng han nhu cd Ihl gdy tai nan nfi'u dieu khiln phuong tifin giao thdng, giao lifi'p ban be.
Cdc rd'i loan dudng lifiu hda thudng gdp la tdo bdn va khfl mifing. Tao bdn di kem theo cam giac khd ndng trong ngudi, bflt rfli khd chiu. Khfl mifing khi^n hg cfl phai ud'ng nudc ihudng xuyen ma vdn cam ihd'y khd.
14£ Nghidn cflu Gla dinh vd Gldl. Quyd'n 22, so 6, tr. 132-144
nudc bol quanh dem lai cam giac hdo nudc luc ndo cung nghT din vd tim nudc ufl'ng. Bfin canh cac tdc dtmg phu k l irfin, cd ngudi cdn phan nan ve vific cd Ihfi hp xud't hifin nhflng trifiu ehung ngfla ngdy ngoai da gdy khd chiu, \';i mdi vdi ngudi cho rang minh bi anh hudng dfin nang luc linh due nhflng khflng rd rfit. "Co nghTa Id ndng cdt ndy vdo nd khd ilu'ri. anh dang ncri the iid\ Id rd't khd mieng. ndi nhiiu Id i dt khd. md khd phdi urmg nfffic lien tue... " (NgudJ diOu iri Mcili,i(lniu-|
Cac tac diing phu xud't hifin nhilu nhd't d Ihdi ky ddu su dung Methadone, dd Id giai doan dd lilu, td glaj doan md gia dinh vd cdng ddng thudng ehu ^ nhifiu den nj:uni cai nghifin, cd thfi la do suquan tdm cua cha me de'n con cai dfi dam bao xem ngudi cai nghifin cd ludn thii \ KL dilu tri hay khdng. hay vdn sfl dung heroin. Dieu ndy da dSn d^n viec ngudi cai nghifin thudng bi hilu Idm Id vdn s u d u n g n u luy nhu trudc ddy, va mdt stf ngudi da phai chflng minh vdi ngudi ihdn bang each xet nghifim nudc lifi'u.
Nhung hilu Idm nay cung gdy nfin nhflng philn phflc vl idm ly cho ngudi difiu tri Methadone, hg lufln cam thd'y tu li vi chua Idy lai dupe long tin vdi mgi ngudi. Giai doan tifi'p theo dugc coi Id giai doan dn dinh. khi dd ngudi cai nghifin sfl dung diu ddn mdi ngay mdt lilu Methadone ihi'ch hpp luy theo mfli ngudi. Du d giai doan ndy cdc lac dung phu giam nhieu so vdi trudc. luy nhifin ede irifiu chung kfi irfin vdn dai dang deo bam ngudi cai nghifin: "Nhffng man ddu. anh ngii iff lite vi- din chien. cif ndm ngu ilidi.
Con bdy gid, dn dinh liiu ren thi nd budn ngu theo gid" (Ngudi dilu in Methadone).
Hodn canh, dieu kien kinh le kho khdn cua gia dinh
Khi duge hdi vl ddi sd'ng ciia nhung ngudi difiu iri Methadone, edu tra Idi thudng gap nhd't dd hodn canh ngheo khd, cd ngudi gpi la bfinh "vifim mang tfli man tinh" cua hp. bdi le cd bao nhifiu tifin hg sfl dung hfi't vao vific hflt xach choi bdi trudc ddy.
Bfin canh dd mdt sd ngudi cdn gap canh ly tan gia dinh do bi vg bo, khdng ai cung cd'p tai chi'nh va ganh vac chuyfin gia dinh. Mot sd ngudi khae eho bifi't, hg bi mde bfinh, phai dilu tri cung lam cho hg id'n liln trong khi khflng lam ra. Ngoai ra, nhflng ngudi nghifin thudng khdng cd nghi nghifip, hon nfla vi trinh dd hgc vd'n tha'p, hg khd cd the tim duge cdng vific thu nhap cao, cung cd ngudi trudc day ed nghe nghifip nhung nay khdng thfi quay lai nghe cu vl hg bi nghifin nfin bi sa thai, nay khdng edn uy tfn de lam vifie nua, hoac cd ngudi do ti'nh dac thu cua nghi nghifip thi du nhir hp khdng thfi quay lai vdi nghi lai xe hoac van hanh may mde vi tdc dune
N g u y d n Le H o a i A n h va c6c t a c gia 143 phu budn ngu. Vd vi vay hy vpng cua nhirng ngudi dicu tri Methadone dd la giup hp la'y lai \'i thfi'va cd ihl tap trung Idm vific kifi'm tiln mac du vdn hp vdn phai duong ddu vdi nhimg tdc dung phu eua thufl'e. "Anh chl mong ud'ng Methadone nidi thdi gian nffa anh se iie'mg din cdi ndy khoang J-2 ndm nffa anh se gidm bin ddn ddn. hdy gid anh dd mdn nguyin ldm rdi"
(Ngudi dilu tri Methadone) Tudn thii quy dinh
Ngudi dugc cai nghifin bang Methadone, hifin duge coi nhu la nhiing bfinh nhan. qua irinh cai dugc coi nhu dilu tri (USAID va FHI. 2008).
Bfinh nhan khi da dap img cdc tifiu chi theo quy dinh, duoc lua chgn dl dilu tri phai ludn thu nghifim ngdt cac nguyfin tdc eua noi dilu tri dudi su giam sat cua bae sy chuyfin mfln. Mac du da duge tu vd'n vl cdc nguyen tdc nay, bfinh nhdn vdn gdp phai mpi sd khd khan ma ddi vdi hg cdn phai rd't quyfi't tdm va cd ky ludt cao mdi cd thfi vugt qua. "Quy dinh d do Id khdng dugc din ud'ng thud'c mudn, khfing dugc mang ma tuy hodc chd't gdy nghien, xip hdng Irinh the ud'ng thiifi'c xong phdi chdo nhdn vien, cdi chdo day Id vffa di lich sit vita di ngitdi ta kiim ira xem minh dd ud'ng chira thdi..." (Ngudi dilu tri Methadone)
Nhimg khd khdn ma hp cho rdng khd tudn thu nhd't la luc ban dau chua quen trong giai doan dd lieu, trong vdi tudn ddu, thdm chf hon, bdc sy se tie'n hanh dilu ehinh lilu eho de'n khi iim dupe lilu Ihi'ch hgp vdi mdi bfinh nhdn, bfinh nhan cdn phai dfi'n hdng ngay vd tuan thfl luyfit dfl'i su hudng ddn cua bac sy. Ve sau, khi da sfl dung lilu dn dinh, hg vdn phai dfi'n co so dilu tri hang ngay de dugc ufl'ng thufl'e theo nhung quy dinh cu the.
Dilu nay se gdy nhung khd khan cho ngudi dilu iri: (i) hp phai dfi'n deu ddn, nghTa la mufl'n thdnh cflng Ihi hg can phai ed mat hdng ngay bat ke ly do gi. Phdn idn ngudi tinh nguyfin cai nghien da chd'p hanh; tuy nhifin (ii) cd nhung irudng hgp, theo hg kl, qua thuc khflng dfi dang thuc hifin: thi du khi edn vdng mdt vdi ngay vi Iy do gia dinh nhu ma chay cudi xin, hay ly do vi cdng vific phai di cdng tac dai ngay. Noi tdm lai, cd kha nhilu philn phflc neu bfinh nhdn phai dfi'n hang ngdy. "Niu ngucri ta khdng bd liiu thi khdng di cong idc dugc, ddn din ngudi ta khdng cd viec Idm, md khdng cd viec ldm ihi ddy Id mot nguy ca ddn din tdt nghien " (Trfch NKTB). Va ne'u nghi tu do. hg bi coi nhu vi pham npi quy. bj lap bifin ban va tfly theo mflc dp se b| tfl chdi dilu tri, da ed nhilu ngudi khflng dap ung dugc yfiu edu nay, va phai chiu nhung he luy. "Em thd'y a dd nhiiu ngudi nghi, hg bi ky ludl nhimg dd Id viic ngudi la, viic cua minh Id ngdy ndo cung phdi din ufi'ng thud'c " (Ngudi dilu tri Methadone). Ngudi cai nghifin
144 Nghidn cflu Gia dinh vi Gldl. Quydn 22, so 6, tr. 132-144
cimg cho bie't ed nhung linh ddng nhflng dd la rat han hflu, thi du trong trudng 1K;P ngirdi eai nghifin cd thi dugc sfl dung tai nhd.
4. Ban luan
Nghifin cflu ndy dugc tiln hdnh khi Chudng trinh cai nghifin Methadone thuc liiOn 9 thdng ddu. Bdi vdy thflng tin thu thdp dugc cd gid tri phan anh giai doan 9 thang ddu tifin eua chUdng trinh, trong khi dd. theo ddi qud trinh mpt ngudi eai nghifin Methadone cdn phai khdng dudi 01 ndm (Bp Y ic, 2010). luy vny. nhflng ihdng tin thu thap dugc c6 gid tri phdn dnh duoc nhung diln bifi'n cua mflt bfinh nhdn tham gia Chuong trinh trong khoang thdi gian dd Id nhung khd khdn ma hp gdp phai ban ddu, kl ca giai doan dugc iua ehpn eai nghifin, giai doan dd lilu \di nhung phan ung cua CO thi dfl'i vdi Methadone va nhihig thfch nghi vl sau khi da dn dmh hfiu (lifiu tri. Ngodi ra cdc thdng tin cdn cho thdy mdi quan hfi giu^
bfinh nhdn vdi cdng ddng vd gia dinh cua hg hodc giua hp va c4n bd y t^, nhd't Id nhflng ihdch thflc vi mdt ihl chdil, tinh ihdn ma mdi ngudi cai nghifin phdi vugt qua, ddc bifit Id trong giai doan dd lilu va nhung trai nghifim cua mdi ngudi bfinh trong sufl't 9 thang dilu tn •
Tdi lieu tham khau
B6 Lao dong Thuong binh va Xa hoi. 2011. B^o cao 69/BC-LDTBXH vl cdng lac cai nghien ma tuy lai Vifil Nam ihcii gian qii.i (Bao cdo s6' 69/ BC-LDTBXH ngay 08 thang 9 ndm 2011). hltp://lhuvienphaplual.vn.
Bo Y tfi'. 2010. Hudng ddn dilu tri lhay the nghifin cdc chdi dang ihutfc phifin bdng thuoc Methadone.
Cue Phong chPng tfi nan xa hpi. Viin phong Thudng true phdng chd'ng ma tuy- B6 Cdng an vd Trung tdm tu va'n Phdp ludt va Chinh sdch vc Y lfi'. HIV/AIDS - Hpi Ludt gia Vifit Nam. Du dn "Danh gia hifiu qua cai nghifin ma tuj va cac bifin phdp phdng ngfla, chdm soc vii dicu tri HIV/AIDS tai cac Trung tdm cua Vifil Nam",
DoanHihi Bay. 2012. Dilu tri nghien bdng Methadone tfl goc nhin kinh te-xa hpi.
hItp://baodientu.chinhphu. vn.
Martin HoU. 2007. "Agency and dependency within treatment: Drug treatment clients negotiating methadone and antidepressants" Social Science &
Medicine 64 (2007) 1937-1947
Nguyin Van Kinh. 2004. "HIV vdn chua chiu dflng". Tgp chi "AIDS vd cgng ddng" s6 412005.
USAID- FHI. 2008. Sd tay thfing tin dieu tri Methadone cho benh nhdn.
