The bustling port city of Hai Phong is a major transportation hub in northern Vietnam, connecting northern provinces with cities around the world. While its strategic location has resulted in rapid economic growth, Hai Phong’s access to international markets has also led to the rise of a lucrative drug trade. By 2007, there were 6,000 registered drug users (mostly heroin users) in the city and an estimated additional 2,000 unreported users. With the highest rate of injecting drug users per 100,000 inhabitants in Vietnam, Hai Phong was an ideal location to pilot a methadone maintenance treatment (MMT) program.

With support from the U.S. Agency for International Development (USAID) and technical assistance from FHI 360’s Sustainable Management of the HIV/AIDS Response and Transition to Technical Assistance (SMART TA) project, Hai Phong established three MMT clinics in 2008. Just six years later, 11 MMT clinics are now serving more than 3,200 patients in Hai Phong, reaching 40 percent of injecting drug users in the city ― the highest rate of MMT coverage of any province in Vietnam.

Improving health, reducing crime 

Known as the gold standard for opioid dependence treatment, MMT has been proven effective in improving the health of individual patients as well as reducing socioeconomic problems associated with drug addiction. Results from an FHI 360-led cohort study demonstrate the wide-ranging impact the MMT program in Hai Phong has had on both individuals and communities: 

• A substantial reduction in illicit drug use. Drug use plummeted from 100 percent at initial enrollment to a mere 8.4 percent after 48 months. Respondents reported no sharing of injection materials, which has significant implications for reducing the spread of HIV. 
• Strong adherence to treatment. Methadone treatment follows a strict protocol, requiring patients to come to the clinics for their daily dosages. Despite these challenges, two-thirds of all patients who started remained in treatment after four years. And, approximately 30 percent of patients were “satisfied” or “very satisfied” with their lives.
• Reducing drug-associated crime. Local authorities and the general public in Hai Phong have welcomed methadone treatment because of the role it plays in reducing crime and public nuisance. Thirty-six percent of patients reported to be engaged in criminal activities at the outset of treatment, whereas a much lower rate, 1.3 percent, reported committing crimes after 48 months of MMT. 

The study identified the need to increase employment opportunities for methadone patients as one area for improvement. There was only minor movement in the employment rate for this group during the four years of the study, with 59.2 percent of patients employed at the beginning of study and 67.1 percent consistently employed by the end. 

Since early 2014, the program has been fully transferred to Hai Phong’s government, transitioning the program from a free service to a more sustainable co-pay service model. In 2014, the Hai Phong authority allocated money to subsidize MMT treatments for patients who now make affordable contributions to the cost of their care. 
The successes in Hai Phong exemplify the joint efforts of USAID and the SMART TA project to scale up MMT in a sustainable way and offer a model for other provinces in Vietnam.

For more information on MMT in Vietnam, please see our video: Scaling up methadone treatment and reducing HIV in Vietnam.