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Steiro A, Hestevik CH, Muller AE. Patient's and healthcare provider's experiences with Opioid Maintenance Treatment (OMT): a qualitative evidence synthesis. BMC Health Serv Res 2024; 24:333. [PMID: 38481254 PMCID: PMC10938774 DOI: 10.1186/s12913-024-10778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Opioid Maintenance Treatment (OMT) is the gold standard for people with opioid dependence. However, drop-out rates are high, and many patients do not reach desired outcomes. Understanding patients' and healthcare providers' experiences with the treatment can provide valuable information to improve the quality of OMT and to increase acceptability and accessibility of services. The aim of this systematic review is to explore and synthesise the experiences of OMT among persons with opioid dependence and health care providers, to inform policy makers and practitioners on how to improve OMT outcomes. METHODS We conducted a qualitative evidence synthesis. We systematically searched in electronic databases (CINAHL, Embase, MEDLINE, and nordic databases) and searched for grey literature. As we identified many studies that met our inclusion criteria, we purposively sampled a manageable number of studies to include in this review. Two researchers independently extracted and coded data from the included studies and used the Andersen's healthcare utilization model to organize and develop codes. We assessed the methodological limitations of the studies, and our confidence in the findings using GRADE CERQual. RESULTS We retrieved 56 relevant studies and purposively sampled 24 qualitative studies of patients' and healthcare providers' experiences with OMT. Our analyses resulted in six main themes: (1) External stigma prevents engagement and retention in treatment, (2) Being identified as in OMT contributed to an increased experience of stigma (3) Inadequate knowledge and expertise among healthcare providers affected patients' treatment experiences, (4) Quality of communication between personnel and patients impacts patients' engagement with treatment and treatment outcomes, (5) Patients wanted help with many aspects of their lives not just medication, and (6) Balancing positive expectations of OMT with treatment stigma. We found that stigma was an overarching theme across these themes. CONCLUSION Our findings suggest that OMT could be more beneficial for patients if treatment programs prioritize efforts to diminish societal and OMT provider stigma and find strategies to better address patient needs. Initiatives should focus on improving treatment knowledge among providers, encouraging the use of client perspectives, considering the context of family members, and establishing a more holistic and flexible treatment environment.
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Affiliation(s)
- Asbjørn Steiro
- Department of Health Services Research, Norwegian Institute of Public Health, Pb 222, 0213, Skoyen, Oslo, Norway.
| | - Christine Hillestad Hestevik
- Department of Health Services Research, Norwegian Institute of Public Health, Pb 222, 0213, Skoyen, Oslo, Norway
| | - Ashley Elizabeth Muller
- Department of Health Services Research, Norwegian Institute of Public Health, Pb 222, 0213, Skoyen, Oslo, Norway
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Coutts-Bain D, Sharpe L, Techakesari P, Forrester MA, Hunt C. A mixed-methods review and meta-synthesis of fears of recurrence and progression in people with mental health conditions. Clin Psychol Rev 2023; 105:102342. [PMID: 37804564 DOI: 10.1016/j.cpr.2023.102342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/23/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
A fear that one's physical illness will recur or worsen has received substantial research attention over the past decade, most notably as fear of cancer recurrence. Indeed, such fear is known to be associated with poorer quality of life, adjustment, and psychopathology. However, fear of a recurrence or progression (FORP) of mental health conditions has received comparatively little study. The present review aimed to, 1) systematically review quantitative research on FORP in mental health regarding its association with age, gender, quality of life, mental health outcomes, and health behaviours, and 2) meta-synthesize qualitative research related to FORP to construct a transdiagnostic model. A qualitative meta-synthesis of 19 studies identified four subthemes underlying FORP (fear of symptoms, loss of progress, fear of death, and traumatic experiences). The three themes related to FORP were: inability to trust oneself, hypervigilance, and a low-risk low-reward lifestyle which was comprised of three subthemes (limiting relationships, limiting life goals, and fear of changing treatment). A quantitative systematic review of 15 studies found that FORP was strongly associated with worse quality of life, and greater depression, anxiety, psychotic symptoms, and medication adherence, but was not associated with age or gender. Hence, FORP can be understood transdiagnostically, and is generally associated with poorer mental health outcomes but may also predict adaptive health behaviours, such as appropriate medication adherence.
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Affiliation(s)
- Daelin Coutts-Bain
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Australia.
| | - Pirathat Techakesari
- School of Psychology, Faculty of Science, The University of Sydney, Australia; Cancer Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Australia; Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Australia
| | | | - Caroline Hunt
- School of Psychology, Faculty of Science, The University of Sydney, Australia
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Soto-Nevarez A, Abo M, Hudson M, Bobak T, Jason LA. Lived experiences of Oxford House residents prescribed medication-assisted treatment. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2828-2844. [PMID: 36994805 DOI: 10.1002/jcop.23038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
Qualitative studies have examined the recovery experiences of individuals prescribed medication-assisted treatment (MAT), including their experiences within treatment facilities. However, the literature lacks qualitative studies exploring the recovery process of individuals prescribed MAT while living in recovery housing, such as Oxford House (OH). The purpose of this study was to explore how OH residents, who are prescribed MAT, make sense of recovery. The fact that OHs are drug-free recovery housing is what makes the issue of using MATs potentially contentious in these settings. Interpretative phenomenological analysis (IPA) was used to document the lived experiences of individuals prescribed MAT in OH. The sample included: five women and three men, prescribed either methadone or Suboxone, that were living in an OH in the United States. Participants were interviewed on four topics: their recovery process, their transition to OH, and their experience living in and outside of an OH. Analysis of results followed the recommendations for IPA from Smith, Flowers, and Larkin. Four general themes emerged from the data: Recovery Process, Managing Logistics of MAT Utilization, Personal Development, and Familial Values. In conclusion, individuals prescribed MAT did benefit from living in an OH to manage their recovery as well as stay compliant with their medication.
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Affiliation(s)
| | - Mary Abo
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Mackenzie Hudson
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Ted Bobak
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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Carlisle VR, Maynard OM, Bagnall D, Hickman M, Shorrock J, Thomas K, Kesten J. Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1526. [PMID: 36674280 PMCID: PMC9865602 DOI: 10.3390/ijerph20021526] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/15/2023]
Abstract
(1) The harm-reduction benefits of opioid agonist treatment (OAT) are well-established; however, the UK government's emphasis on "recovery" may be contributing to a high proportion of people leaving treatment and low retention rates. We wanted to develop a rich and nuanced understanding of the factors that might influence the treatment journeys of people who use OAT. (2) We explored factors at each level of the socioecological system and considered the ways these interact to influence treatment journeys in OAT. We carried out semi-structured interviews with people who use OAT (n = 12) and service providers (n = 13) and analysed data using reflexive thematic analysis. (3) We developed three themes representing participant perceptions of treatment journeys in OAT. These were: (1) The System is Broken; (2) Power Struggles; and (3) Filling the Void. (4) Conclusions: The data suggest that prioritisation of treatment retention is important to preserve the harm-reduction benefits of OAT. Stigma is a systemic issue which presents multiple barriers to people who use OAT living fulfilling lives. There is an urgent need to develop targeted interventions to address stigma towards people who use OAT.
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Affiliation(s)
- Victoria Rice Carlisle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
- School of Psychological Sciences, University of Bristol, Bristol BS8 1TU, UK
| | - Olivia M. Maynard
- School of Psychological Sciences, University of Bristol, Bristol BS8 1TU, UK
| | - Darren Bagnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
| | - Jon Shorrock
- Avon & Wiltshire NHS Mental Health Trust, Specialist Drug and Alcohol Services, Colston Fort, Montague Place, Bristol BS6 5UB, UK
| | - Kyla Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
| | - Joanna Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
- The National Institute for Health and Care Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
- The National Institute for Health and Care Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol BS8 1TL, UK
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Wyse JJ, Lovejoy TI, Gordon AJ, Mackey K, Herreid-O'Neill A, Morasco BJ. "I'm Clean and Sober, But Not Necessarily Free": Perceptions of Buprenorphine Among Patients in Long-Term Treatment. Subst Abus 2023; 44:41-50. [PMID: 37226910 PMCID: PMC11132627 DOI: 10.1177/08897077231165625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patients receiving buprenorphine for the treatment of opioid use disorder (OUD) experience a roughly 50% reduction in mortality risk relative to those not receiving medication. Longer periods of treatment are also associated with improved clinical outcomes. Despite this, patients often express desires to discontinue treatment and some view taper as treatment success. Little is known about the beliefs and medication perspectives of patients engaged in long-term buprenorphine treatment that may underlie motivations to discontinue. METHODS This study was conducted at the VA Portland Health Care System (2019-2020). Qualitative interviews were conducted with participants prescribed buprenorphine for ≥2 years. Coding and analysis were guided by directed qualitative content analysis. RESULTS Fourteen patients engaged in office-based buprenorphine treatment completed interviews. While patients expressed strong enthusiasm for buprenorphine as a medication, the majority expressed the desire to discontinue, including patients actively tapering. Motivations to discontinue fell into 4 categories. First, patients were troubled by perceived side effects of the medication, including effects on sleep, emotion, and memory. Second, patients expressed unhappiness with being "dependent" on buprenorphine, framed in opposition to personal strength/independence. Third, patients expressed stigmatized beliefs about buprenorphine, describing it as "illicit," and associated with past drug use. Finally, patients expressed fears about buprenorphine unknowns, including potential long-term health effects and interactions with medications required for surgery. CONCLUSIONS Despite recognizing benefits, many patients engaged in long-term buprenorphine treatment express a desire to discontinue. Findings from this study may help clinicians anticipate patient concerns and can be used to inform shared decision-making conversations regarding buprenorphine treatment duration.
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Affiliation(s)
- Jessica J Wyse
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Epidemiology & Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katherine Mackey
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Anders Herreid-O'Neill
- Oregon Rural Practice Network (ORPRN), Oregon Health & Science University, Portland, OR, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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Poulsen MN, Asdell PB, Berrettini W, McBryan K, Rahm AK. Application of the COM-B model to patient barriers and facilitators of retention in medication treatment for opioid use disorder in rural Northeastern United States: A qualitative study. SSM. MENTAL HEALTH 2022; 2:100151. [PMID: 36776723 PMCID: PMC9912293 DOI: 10.1016/j.ssmmh.2022.100151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Medications for opioid use disorder (MOUD) reduce illicit opioid use and overdose mortality, but effectiveness remains limited by poor treatment retention. Understanding multilevel barriers and facilitators to retention from the patient perspective can guide intervention strategies to improve retention. Methods We conducted semi-structured telephone interviews to elicit perspectives of individuals with opioid use disorder (OUD) currently (n = 19) and formerly (n = 16) receiving treatment from a multi-clinic outpatient MOUD program in Pennsylvania in July 2020 to January 2021. The Capability, Opportunity, Motivation, Behavior model provided a theoretical framework for analysis. Results Based on interview themes, physical, rather than psychological, capability was more salient to MOUD engagement, and pertained to individual-level factors such as side effects, withdrawal, and the degree to which MOUD addressed participants' need for pain management. Co-existing mental health conditions also challenged participants' physical ability to attend appointments. The opportunity domain contained both physical and social aspects. Physical opportunity for MOUD engagement centered on community-level factors related to MOUD access (e.g., distance, transportation) and clinical-level factors including program policies. Themes related to social opportunity included interpersonal influences-such as therapeutic and social support-and stigma associated with OUD and MOUD. Motivation emerged as the dominant domain for patients. Reflective motivation factors included individual-level factors such as participants' recognition of their addiction and "readiness" to quit illicit opioid use, attitudes toward MOUD, future treatment expectations, motivation to engage in MOUD, and perceived consequences of disengagement. Automatic motivation factors included the degree to which MOUD created a sense of normalcy for participants and the use of illicit drugs to numb emotions. Conclusions Factors at the individual, interpersonal, clinical, community, and societal levels influenced patients' capability, opportunity, and motivation to engage in MOUD. Understanding such factors can inform implementation strategies to improve retention.
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Affiliation(s)
- Melissa N. Poulsen
- Department of Population Health Sciences, Geisinger, Danville, PA, 17822, USA,Corresponding author. 100 North Academy Avenue Geisinger, Danville, PA, 17822, USA. (M.N. Poulsen)
| | - Patrick B. Asdell
- Department of Population Health Sciences, Geisinger, Danville, PA, 17822, USA
| | - Wade Berrettini
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Kortney McBryan
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, 17822, USA
| | - Alanna K. Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, 17822, USA
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Fiddian-Green A, Gubrium A, Harrington C, Evans EA. Women-Reported Barriers and Facilitators of Continued Engagement with Medications for Opioid Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159346. [PMID: 35954700 PMCID: PMC9368271 DOI: 10.3390/ijerph19159346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 12/07/2022]
Abstract
Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling “safe” within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population.
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Affiliation(s)
- Alice Fiddian-Green
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA
- Correspondence:
| | - Aline Gubrium
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
| | - Calla Harrington
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
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Faccio E, Aquili L, Anonymous, Rocelli M. When the non-sharing of therapeutic goals becomes the problem: The story of a consumer and his addiction to methadone. J Psychiatr Ment Health Nurs 2022; 29:174-180. [PMID: 34379854 PMCID: PMC9291105 DOI: 10.1111/jpm.12793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/10/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: It is well known that psychotropic drugs, besides having beneficial effects, may become a source of addiction. Drug therapy involving methadone is traditionally considered an essential medicine in the treatment for heroin dependence since it significantly reduces drug injecting and death rates associated with opioid dependence. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper investigates a paradoxical situation: the use of methadone therapy to maintain a condition of addiction rather than to overcome it. The story is told jointly by the head of a rehab centre and a young man who has developed a methadone addiction and kept it hidden for years from the operators of the addiction centre, who supplied him with the substance. WHAT ARE THE IMPLICATIONS FOR MENTAL-HEALTH NURSING?: The young man's story offers a key example which can be of interest not only for addiction centres but also for all mental-health services that supply drugs as therapy. This study examines what happens when a person taken over by a service pursues goals that are in contrast to the service mission. Specific communication strategies have to be implemented to update and negotiate goals in continuity with the personal live project of the service user. This story is a warning to not rely on consolidated operational practices, ignoring the investigation of personal meanings and aims of those who experience them. ABSTRACT: Introduction Mental health services typically follow standardized intervention protocols and systematic operating practices. Aim/Question This paper explores what happens when a service relies exclusively on fixed practices rather than on the negotiation of objectives and the differentiation of procedures according to the needs of the user. Method The analysis of the narratives produced in first person by Oliver, a former substance user, emphasizes the need of constructing a therapeutic plan in close cooperation, promoting an user active role and strengthening his affiliation in the change process. Results and Discussion In this specific case, the involvement of the user meant the identification of the peculiar meanings he attributed to the "substance of use," which paradoxically coincided with the "therapeutic substance" (methadone). Implications for Practice Oliver's story is an effective mirror for rethinking staff conduct when it assumes that the drug is therapeutic in itself, regardless of the way the person experiences and means it, it also offers a description of the interactive ways in which the relationship between a young person and service staff proved to be effectively therapeutic.
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Affiliation(s)
- Elena Faccio
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Ludovica Aquili
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Anonymous
- Community for Drug Addicts Arcobaleno, Fermo, Italy
| | - Michele Rocelli
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
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Bertz JW, Panlilio LV, Stull SW, Smith KE, Reamer D, Holtyn AF, Toegel F, Kowalczyk WJ, Phillips KA, Epstein DH, Silverman K, Preston KL. Being at work improves stress, craving, and mood for people with opioid use disorder: Ecological momentary assessment during a randomized trial of experimental employment in a contingency-management-based therapeutic workplace. Behav Res Ther 2022; 152:104071. [PMID: 35390535 PMCID: PMC9206864 DOI: 10.1016/j.brat.2022.104071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/21/2022] [Accepted: 03/04/2022] [Indexed: 11/02/2022]
Abstract
Employment problems are common among people with substance use disorders (SUDs), and improving vocational functioning is an important aspect of SUD treatment. More detailed understanding of the psychosocial benefits of employment may help refine vocational interventions for people with SUDs. Here, we used ecological momentary assessment to measure possible affective improvements associated with work. Participants (n = 161) with opioid use disorder were randomized to work (job-skills training) in a contingency-management-based Therapeutic Workplace either immediately or after a waitlist delay. Throughout, participants responded via smartphone to randomly scheduled questionnaires. In linear mixed models comparing responses made at work vs. all other locations, being at work was associated with: less stress, less craving for opioids and cocaine, less negative mood, more positive mood, and more flow-like states. Some of these differences were also observed on workdays vs. non-workdays outside of work hours. These results indicate that benefits associated with work may not be restricted to being actually in the workplace; however, randomization did not reveal clear changes coinciding with the onset of work access. Overall, in contrast to work-associated negative moods measured by experience-sampling in the general population, Therapeutic Workplace participants experienced several types of affective improvements associated with work.
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Nehlin C, Bäckström J, Brander CW, Öster C. Patients’ Perspectives on Coming Off Opioid Agonist Treatment: A Qualitative Study. Subst Abuse 2022; 16:11782218221107021. [PMID: 35754979 PMCID: PMC9218892 DOI: 10.1177/11782218221107021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/21/2022] [Indexed: 11/17/2022]
Abstract
Aims: Opioid agonist treatment (OAT) programs are life-saving, as they reduce opioid use, overdoses, and criminal activities. Disadvantages reported with long-term OAT include side effects of the medication, especially on cognitive ability and sexual function, which may discourage potential participants. Many of those who participate in OAT have a desire to come off treatment. The aims of this study were to explore patients’ thoughts about coming off OAT and to investigate their perceptions of what support they would need in order to realize a planned withdrawal from OAT. Methods: A qualitative interview study with semi-structured interviews, using applied thematic analysis. Persons with experiences of participating in OAT were invited from Swedish programs and a private Facebook community. Results: Fifteen persons, with a mean of 9.6 (±6.4) years of treatment experience, were included. The participants underlined the need for a patient-centered focus within the treatment. They wanted to be regarded as capable of deciding if, when, and how a planned ending was to take place. They also called for staff to be supportive in making such decisions. Participants recommended staff to be sensitive to the needs of the specific patient and to have strategies for coming off OAT that could be adjusted for the single person. Conclusions: OAT programs need to be continually updated and adapted to the persons who can benefit from them. Applying a person-centered, holistic perspective would enhance the quality of the treatment by emanating from individual goals. Regulatory guidelines need to take into account research on patient experiences and perspectives on coming off.
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Affiliation(s)
- Christina Nehlin
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
- Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | - Josefin Bäckström
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
- Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | - Charlotte Wollert Brander
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
- Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | - Caisa Öster
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
- Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden
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Sharp A, Carlson M, Howell V, Moore K, Schuman-Olivier Z. Letting the sun shine on patient voices: Perspectives about medications for opioid use disorder in Florida. J Subst Abuse Treat 2021; 123:108247. [PMID: 33612190 PMCID: PMC8128038 DOI: 10.1016/j.jsat.2020.108247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/13/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
The 2017 declaration of the opioid overdose epidemic as a public health emergency in the United States enhanced a national focus on effective and sustainable treatments for opioid use disorder (OUD), including multiple options utilizing medication. Despite clinical studies demonstrating efficacy, numerous reports suggest that medication for opioid use disorder (MOUD) has been underutilized, leaving many questions about specific barriers and facilitators. This study examines factors impacting attitudes and perspectives related to MOUD that influence its utilization and acceptance in a state where support for harm reduction and treatment policy has been limited. With consideration for the contextual cultural factors of this region, we conducted twelve individual interviews with people seeking treatment for OUD at a detoxification facility in Tampa, Florida. This study called attention to the perspectives of patients regarding their unique self-identified needs and beliefs around MOUD as it relates to their addiction treatment. We evaluated the perspectives collected in the interviews (N = 12) based on three main themes: 1) positive perceptions of MOUD; 2) negative perceptions of MOUD; and 3) overall perceptions of treatment and recovery. Findings suggest that participants' varying levels of positive and negative perspectives about MOUD are informed by nuances in their social networks and varying levels of exposure or education. For example, participants held more negative opinions of MOUD than positive, accounting mostly for a view that it serves as a direct substitute for illicit opioids rather than a sustainable or supportive solution addressing the underlying causes of addiction. These opinions may be largely dependent on geographic location that dictates policy, practice, funding, and, in turn, cultural acceptance of MOUD. The findings in this qualitative study may help to inform future education efforts, initiatives addressing patient-level concerns, and provide decision-makers with meaningful information to tailor programmatic policy and procedures specific to local area social inputs and resource exposure.
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Affiliation(s)
- Amanda Sharp
- University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States.
| | - Melissa Carlson
- University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States
| | - Veronica Howell
- University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States
| | - Kathleen Moore
- University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States
| | - Zev Schuman-Olivier
- Harvard Medical School, Department of Psychiatry, 25 Shattuck St, Boston, MA 02115, United States
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12
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Boloori A, Arnetz BB, Viens F, Maiti T, Arnetz JE. Misalignment of Stakeholder Incentives in the Opioid Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7535. [PMID: 33081276 PMCID: PMC7589670 DOI: 10.3390/ijerph17207535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 12/14/2022]
Abstract
The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients' non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.
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Affiliation(s)
- Alireza Boloori
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
| | - Bengt B. Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
| | - Frederi Viens
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
| | - Taps Maiti
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
| | - Judith E. Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
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13
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Cioe K, Biondi BE, Easly R, Simard A, Zheng X, Springer SA. A systematic review of patients' and providers' perspectives of medications for treatment of opioid use disorder. J Subst Abuse Treat 2020; 119:108146. [PMID: 33138929 DOI: 10.1016/j.jsat.2020.108146] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/02/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The opioid epidemic is a public health crisis. Medications for opioid use disorder (MOUD) include: 1) buprenorphine, 2) methadone, and 3) extended-release naltrexone (XR-NTX). Research should investigate patients' and providers' perspectives of MOUD since they can influence prescription, retention, and recovery. METHODS This systematic review focused on patients' and providers' perceptions of MOUD. The review eligibility criteria included inclusion of the outcome of interest, in English, and involving persons ≥18 years. A PubMed database search yielded 1692 results; we included 152 articles in the final review. RESULTS There were 63 articles about buprenorphine, 115 articles about methadone, and 16 about naltrexone. Misinformation and stigma associated with MOUD were common patient themes. Providers reported lack of training and resources as barriers to MOUD. CONCLUSION This review suggests that patients have significant misinformation regarding MOUD. Due to the severity of the opioid epidemic, research must consider the effects of patients' and providers' perspectives on treatment for OUD, including the effects on the type of MOUD prescribed, patient retention and adherence, and ultimately the number of patients treated for OUD, which will aid in curbing the opioid epidemic.
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Affiliation(s)
- Katharine Cioe
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Breanne E Biondi
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, United States of America
| | - Rebecca Easly
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Amanda Simard
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Xiao Zheng
- Yale University, New Haven, CT 06520, United States of America
| | - Sandra A Springer
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, United States of America; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, United States of America.
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14
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Martinelli TF, Nagelhout GE, Bellaert L, Best D, Vanderplasschen W, van de Mheen D. Comparing three stages of addiction recovery: long-term recovery and its relation to housing problems, crime, occupation situation, and substance use. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1779182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Thomas F. Martinelli
- IVO Research Institute, The Hague, The Netherlands
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Gera E. Nagelhout
- IVO Research Institute, The Hague, The Netherlands
- Department of Health Promotion and Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Lore Bellaert
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - David Best
- The International Centre of Excellence in Policing and Criminal Justice, University of Derby, Derby, England
| | | | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
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15
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Thomas N, van de Ven K, Mulrooney KJD. The impact of rurality on opioid-related harms: A systematic review of qualitative research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 85:102607. [PMID: 31864787 DOI: 10.1016/j.drugpo.2019.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/02/2019] [Accepted: 11/10/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Over the past decade, there has been mounting recognition that opioid use and related mortality and morbidity is a significant public health problem in rural, non-urban areas across the globe. Taking what has been termed the 'opioid crisis' as a starting off point, this article aims to systematically review the qualitative literature on the ways in which rurality shapes the risk for opioid-related harm. METHODS A systematic review was undertaken using database searches and secondary reference list searches for qualitative literature on rural and non-urban opioid-related harms. A total of 32 qualitative studies met the inclusion criteria. Data extraction was performed in NVivo 12 using a codebook based on the 'risk environment' framework. RESULTS The findings explore how rurality shapes the risk environment for opioid-related harms through four environment influences: (1) economic conditions, including economic transition and deindustrialisation that has occurred in many rural areas, and the high levels of economic distress experienced by rural residents; (2) physical conditions, including a lack of infrastructure and recreation opportunities, larger geographic distances, and limited transportation; (3) social conditions, where social networks could be both protective but also amplify risk through a lack of knowledge about treatment and risk behaviours, a lack of anonymity and stigmatisation of people who use opioids in rural areas; and (4) policy conditions including limited coverage and availability of harm reduction and drug treatment services, and stigmatising service provider practices. CONCLUSIONS The impact of rurality on risk of opioid-related harm is multifaceted. We suggest that future research on rural opioid use would benefit from drawing on the theoretical toolkit of rural criminology to attend to the ways the 'rural crisis', and attendant insecurities, anxieties and strains, impacts upon rural communities and shapes risk, along with how socio-cultural characteristics of the rural 'organise' risks of drug use.
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Affiliation(s)
- Natalie Thomas
- Centre for Rural Criminology, University of New England, Armidale, New South Wales, Australia; School of Humanities, Arts, and Social Sciences, University of New England, Armidale, New South Wales, Australia.
| | - Katinka van de Ven
- Centre for Rural Criminology, University of New England, Armidale, New South Wales, Australia; Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia
| | - Kyle J D Mulrooney
- Centre for Rural Criminology, University of New England, Armidale, New South Wales, Australia; School of Humanities, Arts, and Social Sciences, University of New England, Armidale, New South Wales, Australia
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16
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Leather J, Kewley S. Assessing Drama Therapy as an Intervention for Recovering Substance Users: A Systematic Review. JOURNAL OF DRUG ISSUES 2019. [DOI: 10.1177/0022042619845845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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17
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Stein MD, Conti MT, Herman DS, Anderson BJ, Bailey GL, Noppen DV, Abrantes AM. Worries About Discontinuing Buprenorphine Treatment: Scale Development and Clinical Correlates. Am J Addict 2019; 28:270-276. [PMID: 30993833 DOI: 10.1111/ajad.12884] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/06/2019] [Accepted: 03/09/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the benefits of maintenance buprenorphine treatment for opioid use disorder (OUD), many individuals report an interest in discontinuing the medication, while also expressing worries about tapering. The purpose of this study was to develop a measure of worries about buprenorphine discontinuation ("Off Bupe") and determine the demographic and clinical characteristics associated with these worries. METHODS Between May 2017 and May 2018, we surveyed adults in an outpatient primary care buprenorphine program (n = 138). Reliability and validity of the Off Bupe measure were examined. RESULTS Participants averaged 39 years of age, 54% were male, average duration of buprenorphine was 189 weeks and 85.5% reported eventually wanting to discontinue buprenorphine, although fewer than 10% were actively tapering. We derived two scales, withdrawal symptom worry (10 items, ɑ = 0.94) and relapse worry (7 items, ɑ = 0.88). Worry about symptoms was positively associated with current buprenorphine dose (P = 0.016), physical discomfort avoidance (P < 0.001), and inversely associated with self-efficacy to quit buprenorphine (P < 0.001) and distress tolerance (P < 0.001). Worry about opioid relapse was associated positively with age (P = 0.019), current buprenorphine dose (P = 0.004), physical discomfort avoidance (P < 0.001), and impulsivity (P = 0.002), and inversely associated with self-efficacy to quit buprenorphine (P < 0.001). DISCUSSION AND CONCLUSIONS Psychometric evaluation of the "Off Bupe" scale demonstrated its content and construct validity and internal reliability. SCIENTIFIC SIGNIFICANCE The scale might help individuals with OUD and their providers identify concerns about discontinuing buprenorphine. (Am J Addict 2019;28:270-276).
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Affiliation(s)
- Michael D Stein
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Micah T Conti
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island
| | - Debra S Herman
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bradley J Anderson
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island
| | - Genie L Bailey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Stanley Street Treatment and Resources, Inc, Fall River, Massachusetts
| | - Donnell Van Noppen
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island
| | - Ana M Abrantes
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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18
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McQuaid RJ, Dell C. Life in Recovery from Addiction in Canada: Examining Gender Pathways with a Focus on the Female Experience. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1502642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Robyn J. McQuaid
- The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
- Canadian Centre on Substance Use and Addiction, Ottawa, Canada
| | - Colleen Dell
- Centennial Enhancement Chair in One Health and Wellness, Department of Sociology & School of Public Health, University of Saskatchewan, Canada
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19
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Clonidine Increases the Likelihood That Abstinence Can Withstand Unstructured Time in Buprenorphine-maintained Outpatients. J Addict Med 2018; 11:454-460. [PMID: 28759482 DOI: 10.1097/adm.0000000000000345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In a clinical trial examining daily clonidine as an adjunct to buprenorphine treatment for opioid dependence, we found that clonidine increased opioid abstinence and decoupled stress from craving. From a personalized-medicine perspective, the next step is to identify people for whom clonidine would be beneficial. To that end, using data from the same clinical trial, we examined the associations of daily-life activities with treatment success. METHODS Outpatients (N = 118) received clonidine (0.3 mg/d) or placebo during 18 weeks of buprenorphine treatment. Participants carried a smartphone that randomly prompted them 4 times per day to report their moods and activities. Using generalized linear mixed models, we assessed the likelihoods of different types of daily activity as a function of clonidine versus placebo, days of longest continuous opioid abstinence, and their interaction. RESULTS Participants in the buprenorphine-only (buprenorphine plus placebo) control group who engaged in more responsibilities (work and child/elder care) had longer streaks of abstinence, whereas those who engaged in more unstructured-time activities had shorter streaks of abstinence. Conversely, for participants in the buprenorphine-plus-clonidine group, longer streaks of abstinence were associated with higher frequencies of activities associated with "unstructured" time. CONCLUSIONS The study replicates findings that engaging in responsibilities is related to positive treatment outcomes in standard opioid agonist therapy. The pattern of results also suggests that clonidine helped participants engage in unstructured-time activities with less risk of craving or use than they might otherwise have had.
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20
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Jones JL, Mateus CF, Malcolm RJ, Brady KT, Back SE. Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review. Front Psychiatry 2018; 9:277. [PMID: 30140240 PMCID: PMC6094990 DOI: 10.3389/fpsyt.2018.00277] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Despite advances in behavioral and pharmacotherapy interventions, substance use disorders (SUDs) are frequently refractory to treatment. Glutamatergic dysregulation has received increasing attention as one common neuropathology across multiple substances of abuse. Ketamine is a potent N-methyl-D-aspartate (NMDA) glutamatergic receptor antagonist which has been found to be effective in the treatment of severe depression. Here we review the literature on the efficacy of ketamine in the treatment of SUDs. Methods: A systematic review of the PubMed, Scopus, and ClinicalTrials.gov databases was undertaken to identify completed and ongoing human studies of the effectiveness of ketamine in the treatment of SUDs between January 1997 and January 2018. Results and conclusion: Seven completed studies were identified. Two studies focused on alcohol use disorder, two focused on cocaine use disorder, and three focused on opioid use disorder. Both cocaine studies found improvements in craving, motivation, and decreased cocaine use rates, although studies were limited by small sample sizes, a homogeneous population and short follow-up. Studies of alcohol and opioid use disorders found improvement in abstinence rates in the ketamine group, with significant between-group effects noted for up to two years following a single infusion, although these were not placebo-controlled trials. These results suggest that ketamine may facilitate abstinence across multiple substances of abuse and warrants broader investigation in addiction treatment. We conclude with an overview of the six ongoing studies of ketamine in the treatment of alcohol, cocaine, cannabis, and opioid use disorders and discuss future directions in this emerging area of research.
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Affiliation(s)
- Jennifer L Jones
- Medical University of South Carolina, Charleston, SC, United States
| | - Camilo F Mateus
- Medical University of South Carolina, Charleston, SC, United States
| | - Robert J Malcolm
- Medical University of South Carolina, Charleston, SC, United States
| | - Kathleen T Brady
- Medical University of South Carolina, Charleston, SC, United States.,Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Sudie E Back
- Medical University of South Carolina, Charleston, SC, United States.,Ralph H. Johnson VA Medical Center, Charleston, SC, United States
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21
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Strada L, Franke GH, Schulte B, Reimer J, Verthein U. Development of OSTQOL: A Measure of Quality of Life for Patients in Opioid Substitution Treatment. Eur Addict Res 2017; 23:238-248. [PMID: 29161720 DOI: 10.1159/000484239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Quality of life (QOL) of patients in opioid substitution treatment (OST) is increasingly being addressed in research. However, no disease- or treatment-specific instrument is available to assess the QOL of this target population. The purpose of this project was to develop the first QOL instrument for OST patients. METHODS Focus groups with 60 OST patients were analyzed using thematic analysis to elicit key QOL themes as perceived by patients. Identified themes were developed into items and refined through pilot testing and cognitive debriefing. The resulting 82 items were tested in a large sample of OST patients (n = 577). Principal component analysis with varimax rotation was performed to explore a possible factor structure and reduce the number of items. Psychometric properties were assessed. RESULTS Factor analysis revealed 6 subscales accounting for 46.1% of the variance: Personal Development, Mental Distress, Social Contacts, Material Well-being, Opioid Substitution Treatment, and Discrimination. The 38-item instrument demonstrated good to acceptable internal consistency reliability for all subscales (Cronbach's alpha = 0.75-0.88), and good convergent and discriminant validity. CONCLUSION The Opioid Substitution Treatment Quality of Life scale (OSTQOL) is a multidimensional instrument with low respondent and administrator burden. A thorough validation is needed to assess its validity.
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Affiliation(s)
- Lisa Strada
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Helga Franke
- Psychology of Rehabilitation, University of Applied Sciences Magdeburg and Stendal, Stendal, Germany
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Gesundheit Nord, Bremen, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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22
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Grønnestad TE, Sagvaag H. Stuck in limbo: illicit drug users' experiences with opioid maintenance treatment and the relation to recovery. Int J Qual Stud Health Well-being 2016; 11:31992. [PMID: 27765141 PMCID: PMC5073299 DOI: 10.3402/qhw.v11.31992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective of this article is to gain insight into how individuals who frequent open illicit drug scenes experience opioid maintenance treatment (OMT) and investigate how this appears to affect their recovery processes. METHOD By means of the ethnographic method, one of the researchers spent time in an open illicit drug scene over a 1-year span, and gathered data on individuals who frequent the scene on a regular basis, and their experiences with OMT. The data are based on field notes and audiotaped interviews. FINDINGS Four themes emerged as relevant for the participants' experiences with OMT: 1) the loss of hope, 2) trapped in OMT, 3) substitution treatment is not enough, and 4) stigmatization of identity. CONCLUSION The participants found the OMT to be overruling and degrading. Several of the individuals from the illicit drug scene are part of the OMT programme, but as the treatment does not remove painful emotions, they supplement OMT with illegal substances, violate the OMT regulations, and run the risk of being excluded from the programme. In fear of losing the replacement opioid, they conceal parts of the addiction they seek treatment for and end up lying and cheating instead of exploring strategies for reducing and managing the addiction. The patients' relation to the OMT personnel is negatively affected by the need to hide a large portion of their issues. The result is a feeling of hopelessness, increased stigmatization, lack of control and being trapped between two worlds-in limbo, an intermediate state which interferes with the recovery process.
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Affiliation(s)
| | - Hildegunn Sagvaag
- Department of Health Studies, University of Stavanger, Stavanger, Norway
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23
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Larney S, Zador D, Sindicich N, Dolan K. A qualitative study of reasons for seeking and ceasing opioid substitution treatment in prisons in New South Wales, Australia. Drug Alcohol Rev 2016; 36:305-310. [DOI: 10.1111/dar.12442] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/29/2016] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
| | - Deborah Zador
- Drug and Alcohol Services; Justice Health and Forensic Mental Health Network; Sydney Australia
| | - Natasha Sindicich
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
| | - Kate Dolan
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
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