Factors influencing engagement and utilisation of opium tincture‐assisted treatment for opioid use disorder: A qualitative study in Tehran, Iran

Abstract

Introduction. In response to a high burden of opioid use disorder (OUD), Iran established a network of opioid agonist treatment (OAT) centres beginning in 2002. To increase treatment diversity, particularly for patients who use opium as their drug of choice, opium tincture (OT)-assisted treatment was introduced to the network. This study aimed to explore factors influencing OT-assisted treatment selection for OUD in Tehran, Iran. Methods. We conducted 54 in-depth interviews with patients with OUD (n = 33), family members of patients (n = 9) and drug treatment providers (n = 12). Participants were recruited from 12 drug treatment centres across Tehran, between September and November 2019. All interviews were audio-recorded, transcribed and coded in OpenCode 4.02 software and analysed using thematic analysis. Results. Study participants more commonly reported individual-level factors as facilitators (e.g. to reduce harms associated with illicit opioid use, achieve recovery through a gradual dose reduction regimen combined with Congress 60 recovery program) and structural level factors (e.g. low adoption by OAT system and lack of familiarity of treatment providers) as barriers for utilisation of OT-assisted treatment regimens. OT was perceived to produce lower levels of physiological dependence than methadone, but the requirement for twice supervised dosing was restrictive. Low familial and community acceptance were also seen as barriers to access. Discussion and Conclusions. This research identified a range of perceived benefits for OT-assisted treatment ranging from harm reduction to an intermediate step to achieve recovery. However, several structural-, individual-, familial-and community-level barriers impede its availability and acceptability.

Commentary on Nikoo et al.: Challenges in protocol development to optimize outcomes of opium tincture maintenance treatment

“…[9] and higher treatment satisfaction [10] and acceptability [9] compared with methadone maintenance treatment. This finding is also in contrast with the views of patients and treatment providers in Iran, who perceive OT as a safer opioid agonist medication than methadone [11].…”

“…The higher frequency of adverse effects (AEs) in the OT group in Nikoo et al .’s study differs from the findings of previous studies using OT [6, 7] or another morphine‐based medication, slow‐release oral morphine, indicating fewer physical side effects [8, 9], lower depression and anxiety scores [8, 10], an enhanced sense of feeling ‘normal’ [9] and higher treatment satisfaction [10] and acceptability [9] compared with methadone maintenance treatment. This finding is also in contrast with the views of patients and treatment providers in Iran, who perceive OT as a safer opioid agonist medication than methadone [11].…”

Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol

“…Studies evaluating the stigma experiences of persons with SUDs are mainly qualitative in nature [ 21 , 52 , 62 , 98 , 105 , 106 ]. The present study will be one of the few studies addressing addiction-related stigma in Iran that applies a mixed-methods technique to identify suitable strategies to reduce addiction-related stigma and discrimination at PATCs from the perspective of Iranian people who use drugs.…”

“…Further research and needs assessments are required to identify additional strategies for addressing addiction-related stigma [ 42 , 47 , 56 ]. To address the stigma associated with addiction, it is necessary to study the effectiveness and feasibility of stigma-reducing interventions [ 55 , 58 , 62 ].…”

“…While there have been some studies conducted in Iran to explore stigma toward individuals with SUDs, none have offered strategies or methods to mitigate stigma within public treatment settings. Although limited, existing data from small-scale qualitative studies in Iranian healthcare settings indicate the prevalence of discriminatory attitudes toward people with SUDs, manifesting as care refusal, substandard care, excessive precautions, physical distancing, humiliation, and blame [ 30 , 51 , 52 , 55 , 62 – 64 ].…”