Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Robert Heimer

Abstract

Background: High rates of injection drug use and HIV have been found in the fishermen of Kuantan, Malaysia. Medication assisted treatment (MAT) is the most efficacious modality for treating opioid dependence and abuse, yet currently available MAT options appear unsuitable for this population. Therefore this study explores whether depot naltrexone, a new, long-acting type of MAT, would be an acceptable treatment to the fishermen of Kuantan.

Methods: Forty in-depth interviews were conducted with injection drug using fishermen of Kuantan and the neighboring village of Beserah. This report is an interim analysis of 26 of those interviews so far transcribed, translated, and coded in Atlas.ti. All 26 fishermen in this sample were male, of Malay ethnicity, Malaysian-born, and Muslim.

Results: Among the fishermen interviewed, there was extensive experience with both methadone and Suboxone. Those medications were perceived as useful and cost-saving to some, but dangerous and addictive to others. Reactions to naltrexone were similarly mixed. The convenience of once monthly administration and the appeal of having a new option were draws, but the fear of an unfamiliar drug and dislike of losing the capacity to feel pleasure from other drugs were seen as disadvantages.

Conclusions: There is a great need and appetite for a new drug treatment approach for the fishermen of Kuantan. Any intervention offered must have an accessible schedule, be convenient to the jetty, and be inexpensive to its clients. Cultivating alliances within the community of injection drug using fishermen and with the local NGO DIC Pahang could help a new MAT program gain the trust of potential clients.

Comments

This is an Open Access Thesis.

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