A Qualitative Study of Prescribing Doctor Experiences of Methadone Maintenance Treatment

Hout, Marie Claire Van; Bingham, Tim

doi:10.1007/s11469-013-9436-3

Cited by 11 publications

(7 citation statements)

References 52 publications

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“…Similar to other countries, primary care practice based pressures centre on patient behavioural issues and resources required to support longer consultation times due to the health and social care challenges of these patients. Studies have reported on GP reluctance to prescribe methadone due to their fears around patient behavioural issues, the complexities of opioid dependent patients, concerns around workload and the time required to manage such patients, and staff safety [ 4 , 6 , 16 , 17 , 23 – 29 ]. Van Hout and Bingham [ 4 ] have underscored the multiplicity of roles (patient advocate, medical supervisor and detoxification gate keeper) that GPs have when involved in prescribing methadone.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies in 2013 and 2016 indicate a generally positive attitude of prescribing GPs toward methadone treatment. This was also underpinned by their belief that primary care prescribing of methadone is an essential service to drug users in the community, and one that supports a good relationship between the patient and GP [ 4 , 5 ]. Prescribing GPs work closely with both statutory (funded and operated by the Health Services Executive, HSE) and non-statutory (part funded by the HSE through a service level agreement, SLA) organisations to optimise OAT delivery.…”

Section: Introductionmentioning

confidence: 99%

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Optimising treatment in opioid dependency in primary care: results from a national key stakeholder and expert focus group in Ireland

Hout

Crowley²,

McBride³

et al. 2018

BMC Fam Pract

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BackgroundTreatment for opioid dependence in Ireland is provided predominantly by general practitioners (GP) who have undergone additional training in opioid agonist treatment (OAT) and substance misuse. The National Methadone Treatment Programme (MTP) was introduced in 1998, and was designed to treat the opioid dependent population and to regulate the prescribing regimes at the time. The past two decades have seen the increased prescribing of methadone in primary care and changes in type of opioid abused, in particular, the increased use of over the counter (OTC) and prescription medications. Despite the scaling up of OAT in Ireland, drug related deaths however have increased and waiting lists for treatment exist in some areas outside the capital, Dublin. Two previous MTP reviews have made recommendations aimed at improving and scaling up of OAT in Ireland. This study updates these recommendations and is the first time that a group of national experts have engaged in structured research to identify barriers to OAT delivery in Ireland. The aim was to explore the views of national statutory and non-statutory stakeholders and experts on current barriers within the MTP and broader OAT delivery structures in order to inform their future design and implementation.MethodsA single focus group with a chosen group of national key stakeholders and experts with a broad range of expertise (clinical, addiction and social inclusion management, harm reduction, homelessness, specialist GPs, academics) (n = 11) was conducted. The group included national representation from the areas of drug treatment delivery, service design, policy and practice in Ireland.ResultsFour themes emerged from the narrative analysis, and centred on OAT Choices and Patient Characteristics; Systemic Barriers to Optimal OAT Service Provision; GP Training and Registration in the MTP, and Solutions and Models of Good Practice: Using What You Have.ConclusionThe study identified a series of improvement strategies which could reduce barriers to access and the stigma associated with OAT, optimise therapeutic choices, enhance interagency care planning within the MTP, utilise the strengths of community pharmacy and nurse prescribers, and recruit and support methadone prescribing GPs in Ireland.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0792-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimising treatment in opioid dependency in primary care: results from a national key stakeholder and expert focus group in Ireland

Hout

Crowley²,

McBride³

et al. 2018

BMC Fam Pract

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“…[32] Previous studies have made some suggestions to overcome the reluctance in GPs to attend training are discussion groups on practical cases, community based nurse prescribing, and multidisciplinary collaboration. [11,26,33] From our results rose the idea of 'advisory physicians', GPs who are trained in OST management who provide advice to their colleague GPs whenever needed. This can be a timesaving solution and stimulate sharing of knowledge and experience amongst colleagues.…”

Section: Limitations Of the Studymentioning

confidence: 79%

How to overcome hurdles in opiate substitution treatment? A qualitative study with general practitioners in Belgium

Fraeyman

Symons

Royen

et al. 2016

European Journal of General Practice

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“…The keyworker role may provide unique challenges for both service users and staff, with staff having to perform multiple roles including 'gatekeeper' of medications and 'monitor' of treatment adherence (42). This may result in service users feeling the need to withhold information in order to secure their medications (21,25,28,34,(42)(43)(44)(45)(46). The 'monitoring' aspect of the role (for instance, performing drug testing) appeared to be a particular barrier to building trust in client-staff relationships (42):…”

Section: Inter-personalmentioning

confidence: 99%

Factors influencing recovery in opioid substitution treatment: a systematic review and thematic synthesis

Carlisle¹,

Maynard²,

Padmanathan³

et al. 2020

Preprint

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Background and Aims Recovery outcomes for opioid substitution treatment are poorer than those for alcohol and other drugs. In order to understand why this is and to synthesise the findings of a large number of qualitative studies, we conducted a systematic review and thematic synthesis to understand facilitators of and barriers to recovery from opioid dependency. Methods Electronic databases (Pubmed, PsychInfo, CINAHL and Embase) were searched. English language studies exploring the views of adult service user and stakeholders with experiences of opioid substitution treatment were considered for inclusion. Included studies were inductively analysed using thematic synthesis. During analysis, the socioecological model was selected as an analytical framework for organising and making links between themes as it captured the complexity of the topic well. ResultsFrom 3646 screened papers, we included 37 studies reporting the views of 1212 staff and service users. Studies highlighted complex interactions between factors influencing recovery across the five levels of the socioecological model (intrapersonal, inter-personal, organisational, community and policy). Early life experiences of trauma were common; lack of support (both psychological and social) was also a recurring theme resulting in feelings of disconnection and isolation. Stigma played a particularly important role in an individual’s capacity to recover from opioid dependency and cut-across all levels of the socioecological model. Conclusions Interventions targeted at the individual level fail to take account of the complexity of recovery within opioid substitution treatment and may ignore the complex socio-political context that service users and services exist within. Stigma permeates all levels of the opioid substitution treatment system; we suggest that addressing this is likely to improve healthcare encounters, help-seeking, increase access to social support and facilitate community reintegration for individuals receiving opioid substitution treatment.

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A Qualitative Study of Prescribing Doctor Experiences of Methadone Maintenance Treatment

Cited by 11 publications

References 52 publications

Optimising treatment in opioid dependency in primary care: results from a national key stakeholder and expert focus group in Ireland

Optimising treatment in opioid dependency in primary care: results from a national key stakeholder and expert focus group in Ireland

How to overcome hurdles in opiate substitution treatment? A qualitative study with general practitioners in Belgium

Factors influencing recovery in opioid substitution treatment: a systematic review and thematic synthesis

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