Integrating evidence-based methamphetamine interventions into methadone clinics: Structural barriers and...

Integrating evidence-based methamphetamine interventions into methadone programs is critical to address increasing methamphetamine use among methadone patients. This study examined the barriers and facilitators of implementing such integration in Vietnam.

We conducted a qualitative study nested within an adaptive trial, Screen, Treat and Retain Meth-Using People with Opioid Use Disorder in Methadone Clinics (STAR-OM), integrating evidence-based methamphetamine interventions into 15 methadone clinics. Seventy-six in-depth interviews were conducted with participants and methadone providers to seek their experience implementing or receiving the study interventions. Interview guides were based on the Consolidated Framework for Implementation Research. Data was analyzed using thematic analysis to identify and explore key themes.

Results reflected a tension between strong clinical support for integrating methamphetamine interventions and substantial structural constraints. The main facilitator was the perceived impact of interventions driven by social accountability and engagement with peers, providers and family members. Key barriers operated primarily at structural levels and included: (1) restrictive policy environments despite local demand for intervention; (2) workforce precarity and limited financial resources, particularly for contingency management; and (3) logistical implementation challenges such as organizing group sessions, burdensome urine testing, falsified urine samples and limited use of SMS-based reminders.

While evidence-based methamphetamine interventions were widely perceived as beneficial, major barriers existed at the policy and program levels. Macro-level actions - such as advocating for more harm reduction - oriented drug policies and strengthening workforce capacity - alongside pragmatic, clinic-level implementation strategies are essential for the sustainable adoption and scale-up of evidence-based methamphetamine interventions within Vietnam's methadone program.