Between efficacy and ambivalence: Family perceptions of Methadone Maintenance Therapy in Malaysia

Opioid dependence remains a major health and social challenge in Malaysia. Methadone Maintenance Therapy (MMT), introduced nationally in 2005, has demonstrated effectiveness in reducing illicit opioid use, HIV transmission, and improving quality of life. This study addresses a critical gap by exploring family members' perceptions of MMT, a crucial yet understudied factor in recovery within Malaysia's collectivist culture.

A qualitative study using an interpretive phenomenological approach was conducted. Twenty immediate family members of MMT clients were purposively recruited from two One-Stop Centre for Addictions (OSCA) primary care clinics in Malaysia. In-depth interviews were conducted in Malay or English, audio-recorded, transcribed verbatim, and analysed thematically using NVivo 12.

Participants' mean age was 39.7 years. Most were spouses (60%), followed by mothers (20%), siblings (15%), and one daughter (5%), with 90% cohabiting with the MMT client. Three key themes emerged: (1) restored functionality and social reintegration, including improved emotional regulation, cessation of violence, and return to employment; (2) familial validation of MMT efficacy, with recognition of reduced cravings, absence of withdrawal symptoms, and behavioural evidence of abstinence; and (3) stigma-experience conflict, where profound ambivalence persisted due to misconceptions, safety fears, and negative social attitudes.

This study provides the first Malaysian evidence on family perceptions of MMT, highlighting its dual role in restoring family stability while facing persistent stigma. Family attitudes prove pivotal to treatment adherence and recovery outcomes, underscoring the urgent need for policy reform toward family-inclusive, stigma-reducing approaches within national harm reduction frameworks.