Increased Somatic Morbidity in the First Year after Leaving Opioid Maintenance Treatment: Results from a Norwegian Cohort Study

Skeie, Ivar; Brekke, Mette; Clausen, Thomas; Gossop, Michael; Lindbæk, Morten; Reinertsen, Even; Thoresen, Magne; Waal, Helge

doi:10.1159/000345229

Cited by 9 publications

(11 citation statements)

References 50 publications

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“…Research has shown that mortality in this group of aging patients in OMT is more associated with comorbid somatic conditions, rather than ongoing illicit drug use [3,8,9]. A Norwegian comparison of 149 patients continuously in OMT with 51 "interrupters" showed a reduction in drug-related somatic problems for the continuous patients, but no difference in the amount of non-drug-related somatic problems between the two groups [10]. On one hand, this is a testament to OMT reducing illicit drug use over time.…”

Section: Introductionmentioning

confidence: 99%

Large and non-specific somatic disease burdens among ageing, long-term opioid maintenance treatment patients

Medved

Clausen

Bukten

et al. 2020

Subst Abuse Treat Prev Policy

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Objectives To describe and explore somatic disease burdens of ageing long-term patients in opioid maintenance treatment (OMT), a unique population emerging in countries offering OMT as a long-term treatment. Methods We used data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). 156 patients enrolled for at least three of the past five years provided data during structured interviews, including on chronic conditions, somatic treatment received, mental distress (SCL-25), and treatment satisfaction. A somatic disease burden was calculated from a list measuring the recent severity of 16 somatic complaints. A hierarchical multiple linear regression analysis identified correlates of somatic disease burden. Results Over half of patients reported at least seven somatic complaints. Reported somatic disease burden was associated with higher mental distress, more chronic conditions, fewer years in OMT, and treatment dissatisfaction. Age was unrelated, and there were few gender differences. These five variables explained 43.6% of the variance in disease burden. Conclusion Long-term OMT patients experience a large range of somatic complaints, and at non-acute levels. As OMT secures longevity for opioid-dependent persons, the clinical focus must be adjusted from acute to chronic care. Providers must address how to optimize health and quality of life while in treatment, as treatment may last for many years.

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Section: Introductionmentioning

confidence: 99%

Large and non-specific somatic disease burdens among ageing, long-term opioid maintenance treatment patients

Medved

Clausen

Bukten

et al. 2020

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

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“…Long-term treatment is indicative of reduced drug use, increased social functioning, and an increase in mental well-being (Fingleton, Matheson, & Holland, 2015 ; Jones, 2007 ). Interrupted treatment, however, is indicative of increased drug use and somatic issues (Skeie et al, 2013 ). As it achieves several goals, OMT is thus viewed as a successful method for treating opioid dependence.…”

mentioning

confidence: 99%

Stuck in limbo: illicit drug users’ experiences with opioid maintenance treatment and the relation to recovery

Grønnestad

Sagvaag

2016

International Journal of Qualitative Studies on Health and Well

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ObjectiveThe objective of this article is to gain insight into how individuals who frequent open illicit drug scenes experience opioid maintenance treatment (OMT) and investigate how this appears to affect their recovery processes.MethodBy means of the ethnographic method, one of the researchers spent time in an open illicit drug scene over a 1-year span, and gathered data on individuals who frequent the scene on a regular basis, and their experiences with OMT. The data are based on field notes and audiotaped interviews.FindingsFour themes emerged as relevant for the participants’ experiences with OMT: 1) the loss of hope, 2) trapped in OMT, 3) substitution treatment is not enough, and 4) stigmatization of identity.ConclusionThe participants found the OMT to be overruling and degrading. Several of the individuals from the illicit drug scene are part of the OMT programme, but as the treatment does not remove painful emotions, they supplement OMT with illegal substances, violate the OMT regulations, and run the risk of being excluded from the programme. In fear of losing the replacement opioid, they conceal parts of the addiction they seek treatment for and end up lying and cheating instead of exploring strategies for reducing and managing the addiction. The patients’ relation to the OMT personnel is negatively affected by the need to hide a large portion of their issues. The result is a feeling of hopelessness, increased stigmatization, lack of control and being trapped between two worlds—in limbo, an intermediate state which interferes with the recovery process.

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“…It is possible that the group of patients with heroin poisoning has changed as the opioid maintenance therapy programs have expanded. They may have become a more troubled group of patients, not managing to enter or remain in opioid maintenance programs, hence with a higher risk of repetition [ 34 ].…”

Section: Limitationsmentioning

confidence: 99%

Follow-up of young patients after acute poisoning by substances of abuse: a comparative cohort study at an emergency outpatient clinic

et al. 2016

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BackgroundYoung patients with acute poisoning by substances of abuse have increased mortality rates in the long term. In Oslo, Norway, most of these patients are treated at the Oslo Accident and Emergency Outpatient Clinic. The majority were discharged without follow-up. In 2010, the clinic implemented an intervention program for patients under the age of 23 presenting with acute poisoning by substances of abuse. The intervention was a brief motivational interview with a social worker before discharge, followed by a telephone consultation. Patients in need of further follow-up were identified and referred. Our objective was to study short-term effects of the intervention program on referrals to follow-up and repetition rates of acute poisoning.MethodsComparative cohorts were derived from studies of acute poisoning at the Oslo Accident and Emergency Outpatient Clinic in 2003, 2008 and 2012. Two age groups of patients presenting with acute poisoning by substances of abuse were included: 16–22 years and 23–27 years. Patients in the pre-intervention cohorts of 2003 and 2008 were compared with patients of the same age in the post-intervention cohort of 2012. Repetition rates were estimated using survival analysis. In total, 1323 patients were included; 422 in the younger pre-intervention group, 366 in the younger post-intervention group, 288 in the older pre-intervention group, and 247 in the older post-intervention group. Overall, the major toxic agents were ethanol 823/1323 (62 %) and opioids 215/1323 (16 %). 719/1323 (54 %) patients were male.ResultsIn the younger groups referrals to follow-up increased from 86/317 (27 %) to 156/366 (43 %) (p < 0.001) after the implementation of the program. Among the older patients, who were not included in the program, there was no significant change in referrals. There was no change in the repetition rate of acute poisoning in either age group. The program established contact with 225/366 (61 %) of the eligible patients.ConclusionMore patients were referred to follow-up after the intervention. We expect this to have a beneficial effect on their substance use and reduce excess morbidity and mortality in the long term. There was no change in the repetition rate of poisoning.

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Increased Somatic Morbidity in the First Year after Leaving Opioid Maintenance Treatment: Results from a Norwegian Cohort Study

Cited by 9 publications

References 50 publications

Large and non-specific somatic disease burdens among ageing, long-term opioid maintenance treatment patients

Large and non-specific somatic disease burdens among ageing, long-term opioid maintenance treatment patients

Stuck in limbo: illicit drug users’ experiences with opioid maintenance treatment and the relation to recovery

Follow-up of young patients after acute poisoning by substances of abuse: a comparative cohort study at an emergency outpatient clinic

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