Socio-Demographic and Clinical Aspects of Dropouts from CEPIAD’s Methadone Program between January 2015 and December 2020

Context: Launched on 27 January 2015, CEPIAD’s methadone program, the first in West Africa, has seen a gradual ramp-up. However, despite the success of the first 2 years with massive inclusions, withdrawals from the program have been noted. This situation raised questions within the CEPIAD team, which decided to carry out this study. Objective: The aim of this work is to understand the reasons for discontinuation in order to adapt treatment strategies and improve patient retention in the program. Methodology: We conducted a retrospective descriptive study including patients enrolled in the methadone program who stopped between January 2015 and December 2020. Data were entered in Excel and analyzed using R software version 4.2.2. Results: The study involved a population with a mean age of 47.5 years, with participants aged between 19 and 75 years. The majority of patients were men (89.2%), while women accounted for 10.8%. Education levels varied: 8.3% of patients had no formal education, 36.6% had primary education, 16.7% secondary education and 14.2% higher education. Marital profiles were also diverse, with 22.5% single, 30.8% married, 37.5% divorced and 5% widowed. In terms of accessibility, 46.6% of patients lived close to CEPIAD, while 32.5% lived further away, increasing distance-related constraints. Of the patients, 69.2% lived in the suburbs of Dakar, while 21.7% lived in the city of Dakar. A history of incarceration was common, affecting 52.5% of patients. Clinically, 94.2% of patients were severely addicted to opioids, while 1.7% were moderately or mildly addicted. Initial methadone doses were mainly between 20 and 40 mg (86.5%), with varying titration: 49% received a maintenance dose of less than 60 mg, which may have contributed to dropout. Average follow-up was 21 months. Mental co-morbidities affected 8.3% of patients, while physical co-morbidities included HIV (4.8%), HCV (7.8%), HBV (2.4%) and tuberculosis (4%). In addition, 95% of urine tests were positive, with a high incidence of multiple use of substances such as tobacco (75%), cannabis (15%) and alcohol (5%). Methadone side effects, mainly constipation (28%), abdominal pain (3.3%) and hypersudation (1.7%), were also identified as factors influencing the methadone discontinuation rate. Conclusion: The results of this study highlight the complexity of methadone substitution treatment, and the need for an individualised approach incorporating socio-demographic and clinical specificities to improve retention in the program. The data suggest the