Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Opioid maintenance treatment: trajectories in and out of treatment
Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).ORCID iD: 0000-0002-1749-4727
Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).ORCID iD: 0000-0002-8158-0486
2019 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 1, p. 24-30Article in journal (Refereed) Published
Abstract [en]

Problem: Although efficacy studies of opioid maintenance treatment (OMT) have shown evidence of treatment benefits, there is still need for studies on its effectiveness in natural clinical processes. This study investigates the development in health, substance use and social conditions of those who applied for OMT, including those denied access or discharged.

Method: First, persons assessed for admittance in 2005–2011 (n = 127) were categorized into four trajectory groups based on whether they were admitted or denied (n = 19), discharged (n = 31), readmitted (n = 21) or had been undergoing OMT without interruption (n = 56). Second, 99 of these, the analytical sample, were interviewed at follow-up using (a) the Addiction Severity Index (ASI) for seven problem-areas and housing, and (b) self-rated change in 11 problem areas. The ASI was compared to baseline interviews after 55 months (mean). Third, outcomes within groups was studied in relation to alternative interventions.

Results: Within the analytical sample, those denied OMT showed no improvements at group level, those discharged had some improvements, more if readmitted than if not and those with uninterrupted OMT showed the most comprehensive improvements. Those outside OMT, denied and discharged, had considerable mortality risks related to ongoing drug use, especially in lack of well-planned alternative interventions.

Conclusion: Improvements strongly relate to access to OMT. This study underscores that access to OMT improves the situation in all areas investigated and decreases the risk for drug-related death. It underscores the importance of two major risk situations, i.e. being denied OMT and being discharged.

Place, publisher, year, edition, pages
Taylor & Francis, 2019. Vol. 73, no 1, p. 24-30
Keywords [en]
Opioid maintenance treatment, drop-outs, treatment outcome, treatment process
National Category
Social Work
Identifiers
URN: urn:nbn:se:hj:diva-42623DOI: 10.1080/08039488.2018.1539120ISI: 000466445300004PubMedID: 30636473Scopus ID: 2-s2.0-85060035376Local ID: HOA HHJ 2019OAI: oai:DiVA.org:hj-42623DiVA, id: diva2:1278224
Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-06-14Bibliographically approved
In thesis
1. En dyster parentes – opiatregeln i svensk LARO-behandling 2010–2016
Open this publication in new window or tab >>En dyster parentes – opiatregeln i svensk LARO-behandling 2010–2016
2019 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
A dismal parenthesis – The opiate rule in Swedish opioid maintenance treatment 2010–2016
Abstract [en]

Opioids are well documented to arouse euphoria, relieve pain, and to have a high dependency potential. Opioid dependence is a serious chronic condition with a high risk of extensive worsened health, relapse and premature death.

Opioid maintenance treatment (OMT) is well researched and has strong scientific support. In Sweden, OMT over time was subjected to polarised and infected political debate and has been strictly regulated by the National Board of Health and Welfare (NBHW). During 2010–2016 NBHW redefined the diagnostic concept of “opiate dependence” in the regulation SOSFS 2009:27. Dependence to only three opioids: heroin, opium or morphine, could give eligibility to OMT (here called the “opiate rule”). The purpose stated was to prevent those dependent to other opioides, e.g. buprenorphine,from receiving OMT. Applicants with severe opioid dependence were thereby divided into two subgroups: those with “opiate” dependence related to heroin, morphine or opium, and those with opioid dependence who lacked documentation in relation to the three opiates. The question is whether there were differences between these groups concerning problem severity or substance-related diagnostics that could justify differences in access to OMT?

A population (n = 127) actualised for OMT during 2005-2011 in Jönköping County is studied regarding severity of problems, diagnostics and trajectories in and out of treatment. In order to provide precise drug use data, a cognitive tool for taking anamnestic information, called the Drug List, was developed.

In Study I, using the Addiction Severity Index, the two groups were found to be quite similar in severity of health problems, social situation and drug problems, including overdoses and injections.

In Study II, the Drug List was found to be superior to a traditional way of taking anamnestic data, more sensitive and giving more precise data, without taking more time. Validity was shown in relation to faked drugs.

In Study III, using a structured diagnostic interview, ADDIS, with the Drug List, showed that both two groups qualified for severe opioid dependence, that opiates and other opioids had contributed equally to the development of opioid dependency, and that the two groups also had similar additional substance dependence problems.

Study IV investigated how “the opiate rule” affected practice by interviewing representatives of OMT clinics as well as a representative of a users’ association. The regulation created dilemmas for clinics as well as for users. Users developed a strategy of getting "negative merits" for being eligible to OMT. Clinicians developed strategies to find ways “around” the regulation in order to admit patients in OMT.

Study V followed those who had applied for OMT and found four trajectory subgroups – those denied OMT, those discharged, those readmitted, and those who remained in treatment. The study provides evidence for a more positive development being related to more involvment in OMT concerning health, social situation as well as substance use problems. Being denied or discharged is related to increased risks of a negative development.

The thesis conclude that there was no support for dividing applicants according to “the opiate rule”. The purpose of top-down control using regulations, is to guarantee uniform and knowledge-based care. In this case the regulation had negative effects in these respects, increasing risks for the applicants, and lost credibility from the profession. The opiate rule in SOSFS 2009:27 is therefore a dismal parenthesis in the history of OMT in Sweden, and could be studied to prevent similar mistakes in the future.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2019. p. 152
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 095
Keywords
opiates, opioids, opioid maintenance treatment, methadone, buprenorphine, regulation, National Board of Health and Welfare, opiater, opioider, opioidberoende, buprenorfin, metadon, läkemedelsassisterad behandling, föreskrift, Socialstyrelsen
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-43443 (URN)978-91-85835-94-2 (ISBN)
Public defence
2019-05-10, Forum Humanum, Hälsohögskolan, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMedScopus

Authority records BETA

Monwell, BodilGerdner, Arne

Search in DiVA

By author/editor
Monwell, BodilGerdner, Arne
By organisation
HHJ, Dep. of Social WorkHHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue)
In the same journal
Nordic Journal of Psychiatry
Social Work

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 54 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf