High and low threshold service provision in drug-free settings: Practitioner views

Eversman, Michael H.

doi:10.1016/j.drugpo.2010.03.005

Cited by 6 publications

(3 citation statements)

References 39 publications

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“…There is an extensive literature evaluating and comparing different types of OPT, but studies are largely confined to analyses of detoxification versus maintenance, and assessments of specific medicines, such as methadone, buprenorphine, lofexidine, levomethadyl acetate, and naltrexone (Kleber, 2007; Mattick, Breen, Kimber, & Davoli, 2014; Stotts, Dodrill, & Kosten, 2009). While most of this literature is based on biomedical or clinical studies, social scientists have used qualitative and quantitative methods to capture both treatment provider perspectives (e.g., Berg, Arnsten, Sacajiu, & Karasz, 2009; Eversman, 2010; Larance et al, 2011; Lin et al, 2010; Philbin & Zhang, 2010) and patient perspectives (e.g., Anstice, Strike, & Brands, 2009; Conner & Rosen, 2008; Harris & McElrath, 2012; Lin, Wu, & Detels, 2011; Nyamathi et al, 2007; Treloar, Fraser, & Valentine, 2007). For example, numerous qualitative studies have used one-to-one interviews and focus groups (FGs) to provide in-depth insights into patients’ views and experiences of accessing and receiving methadone, the most frequently prescribed treatment for opioid use disorder globally (e.g., Jones, Power, & Dale, 1994; Koester, Anderson, & Hoffer, 1999; Murphy & Irwin, 1992; Neale, 1998, 1999a,b; Sohler et al, 2013).…”

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confidence: 99%

Patient views of opioid pharmacotherapy biodelivery systems: Qualitative study to assist treatment decision making.

Neale

Tompkins

Strang

2018

Experimental and Clinical Psychopharmacology

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The technology for delivering opioid pharmacotherapy (OPT) is expanding. It is important to know what OPT patients think of these developments, and to find ways of enabling patients and clinicians to make informed decisions about which bio-delivery system to choose. We explored the views of current and former OPT patients with a history of heroin use to identify factors influencing their preferences regarding routes of OPT administration. Data were generated via seven focus groups conducted in London, United Kingdom. Participants (n=44) considered standard bio-delivery systems (liquid/linctus, tablet, injectables), emergent systems (implants, depot injections), and a hypothetical system (nasal sprays). Groups were audio-recorded, transcribed verbatim, coded using qualitative software, and analyzed inductively via Iterative Categorization. Participants were cautious of, but willing to consider, new ways of receiving OPT and they welcomed having more choice. Their preferences and decision-making processes were influenced by nine interconnected factors: 1. personal dislike of particular bio-delivery systems; 2. desired feelings following OPT administration; 3.perceived effectiveness of OPT bio-delivery systems; 4. concerns about side effects; 5. ability to control the OPT; 6. impact on daily lives; 7. concerns about OPT-related stigma; 8. need for psychosocial support; and 9. personal treatment goals. This complexity may make it difficult for patients and clinicians to evaluate the pros and cons of the expanding array of OPT bio-delivery systems and to arrive at clear conclusions. We therefore use the findings to Article accepted by Experimental and Clinical Psychopharmacology 3 construct a checklist that may facilitate discussions with patients when decisions about OPT need to be made. KEYWORDS

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confidence: 99%

Patient views of opioid pharmacotherapy biodelivery systems: Qualitative study to assist treatment decision making.

Neale

Tompkins

Strang

2018

Experimental and Clinical Psychopharmacology

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“…Service providers have reported encountering many challenges in engaging with and responding to the needs of clients within low-threshold services (Eversman, 2010), as did the practitioners in this study. Of particular note were concerns about managing risk to staff and other service users, for example, onsite dealing or violence that compromised or posed a risk to staff or other service users.…”

Section: Discussionmentioning

confidence: 73%

“…Despite these apparent advantages, the concept of low threshold has also been subject to criticism. It can be difficult to define thresholds (Islam et al, 2013) and in removing barriers to access there may be concerns about the safety of staff, service users and the local communities (Eversman, 2010). Several ethical issues have also been raised associated with onsite drug dealing and taking, levels of intoxication while engaged with practitioners, and service user non-engagement with health services (Solai et al, 2006).…”

Section: Harm Reduction and Low-threshold Service Provisionmentioning

confidence: 99%

Challenges, relationship and outcomes in low-threshold drug services

Morton

O'Reilly²

2018

DAT

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Purpose This paper reports on the findings of an action research study that sought to explore the development and provision of community-based low-threshold services within a socially disadvantaged area. In the context of debates, in regard to both the nature and efficacy of low-threshold drugs services and increasingly neo-liberal policy approaches to drug service provision that prioritise outcomes and drug treatment interventions, the purpose of this paper is to report on practitioners’ understandings of challenges, relationship building and outcomes within community-based low-threshold service provision in Dublin, Ireland. Design/methodology/approach An action research method of co-operative inquiry groups was utilised, with nine practitioners from one community-based drug agency participating in a series of four sessions over a three-month period. Findings Three key themes emerged in relation to building and sustaining client–practitioner relationships: the mechanisms by which the practitioners engaged with their clients and sought to develop relationships; how safe spaces were created and maintained in order to address client needs; and practitioners’ understanding of challenges and outcomes in low-threshold intervention work. Originality/value Drawing on a co-operative inquiry method, this paper concludes that practitioner attention to relational distance evidenced in community-based low-threshold service provision, may provide an alternative to episodic, outcome driven drug treatment and intervention.

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Thresholds in a low-threshold setting: An empirical study of barriers in a centre for people with drug problems and mental health disorders

Edland-Gryt¹,

Skatvedt²

2013

International Journal of Drug Policy

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High and low threshold service provision in drug-free settings: Practitioner views

Cited by 6 publications

References 39 publications

Patient views of opioid pharmacotherapy biodelivery systems: Qualitative study to assist treatment decision making.

Patient views of opioid pharmacotherapy biodelivery systems: Qualitative study to assist treatment decision making.

Challenges, relationship and outcomes in low-threshold drug services

Thresholds in a low-threshold setting: An empirical study of barriers in a centre for people with drug problems and mental health disorders

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