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  • 1.
    Monwell, Bodil
    et al.
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Department of dependency, Psychiatric Clinic, County Hospital Ryhov, Jönköping, Sweden.
    Bülow, Per
    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). Psychiatric Clinic, County Hospital Ryhov, Jönköping, Sweden.
    Johnson, Björn
    Department of Social Work, Malmö University, Malmö, Sweden.
    The pros and cons of supervised urine tests in opioid replacement therapy: A study of patients' experiences2018In: Heroin Addiction and Related Clinical Problems, ISSN 1592-1638, Vol. 20, no 6, p. 5-15Article in journal (Refereed)
    Abstract [en]

    Background and aim: In opioid maintenance treatment (OMT), drug testing is performed continuously to ensure that patients are taking their prescribed medication, and to detect whether they have taken other, non-prescribed, substances. Typically, supervised urine testing is conducted, and in Sweden such testing is often a treatment precondition. This study investigates OMT patients’ experiences of and views on supervised urine testing.

    Methods: Structured interviews were conducted with 90 Swedish OMT patients. During the interview, patients were asked to say what they thought about the supervised urine tests required. The answers were then analysed through content analysis.

    Results: Three main themes with sub-themes were found in the patients’ statements. 1) The consequences of the test results (sub-themes: external control can provide assurance; proven drug intake may have negative consequences for patients; proven drug abstinence can yield advantages for patients), 2) The testing procedures (sub-themes: supervised urine testing is humiliating and causes harm; how you are treated is important; clinical culture and attitudes differ; stress, pressure and anxiety – tests can be difficult to perform), and 3) The structure of the testing (sub-themes: structure is needed in life; inflexible testing schemes can interfere with treatment goals; gathering people with similar problems can be counterproductive).

    Conclusions: Most interviewees found the testing functional as support or as proxy control in case of personal loss of control. However, supervised urine testing also constitutes a severe invasion of privacy. Less demeaning testing methods need to be developed and implemented.

  • 2.
    Monwell, Bodil
    et al.
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Department of Dependence, Psychiatric Clinic, County Hospital Ryhov, Jönköping, Sweden.
    Gerdner, Arne
    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).
    Opiates versus other opioids – are these relevant as diagnostic categorizations?2017In: Heroin Addiction and Related Clinical Problems, ISSN 1592-1638, Vol. 19, no 6, p. 39-48Article in journal (Refereed)
    Abstract [en]

    Background:

    For more than three decades, the international diagnostic systems have used the term ‘opioids’, including opiates, yet research publications continue to use an older terminology. In 2010, new Codes of Statutes for “opiate replacement therapy” (ORT) was brought into effect in Sweden, stating that only those “dependent on opiates” – explicitly described as heroin, morphine or opium – were eligible. Those addicted to other opioids were then denied access. This study examines the relevance of the distinction of opiates vs. other opioids. Are there differences in the severity of opioid dependence or concerning other substance-related diagnoses?

    Methods:

    Ninety-nine individuals participated: 1) the opiate group (n = 69), and 2) the other opioids group (n=30). Structured interviews covered the ICD-10 criteria of nine different types of addictive substances. For opioids, questions were asked separately in relation to opiates versus other opioids.

    Results:

    The two groups fulfilled the criteria for opioid dependence to the same extent, with most participants meeting all six criteria, so indicating a severe opioid dependence problem. Both opiates and other opioids had contributed to their development of opioid dependence, and both groups, to the same high degree, showed comorbidity affecting other dependence conditions.

    Conclusions:

    This study reveals that the two categories of opioids used contribute to the development of opioid dependence and that the term ‘opioids’ can be suitably used to convey a unitary concept in diagnostic terms. There was no support for treating the two groups differently. The study calls for more stringent use of terminology in accordance with the international diagnostic systems.

  • 3.
    Monwell, Bodil
    et al.
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Gerdner, Arne
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Type of opioid dependence: Are there differences in background and severity of problems? 2017In: Heroin Addiction and Related Clinical Problems, ISSN 1592-1638Article in journal (Refereed)
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