Long-Term Opioid Agonist Treatment Participation after First Treatment Entry is Similar across 4 European Regions but Lower in Non-Nationals

Abstract

Heroin users in opioid agonist treatment (OAT) show markedly reduced heroin consumption, less crime and a lower mortality rate. However, the extent of long-term OAT participation over subsequent treatment episodes remains unclear. We analysed the annual proportion of patients in treatment (at least 1 day) since the start of first OAT in 4 European regions: Barcelona (BA) 1996–2012: 8,602 patients; Czech ­Republic (CZ) 2000–2014: 4,377 patients; Netherlands (NL) 1994–2014: 33,235 patients, Zurich (ZU) 1992–2015: 11,795. We estimated the long-term decline of treatment need due to mortality or abstinence and also a “nuisance” short-term decline until the equilibrium level of cycling in and out of OAT is reached to obtain the adjusted treatment participation value. The adjusted treatment participation was around 50% (BA: 47.4–51.4%; CZ: 49.8–53.9%; NL: 52.3–54.0%; ZU: 46.4–49.3%), and the annual decline of treatment need was close to 4%. Non-nationals (NL patients with a migrant background) showed substantial lower adjusted treatment participation (rate ratio BA: 0.059–0.343; NL: 0.710–0.751; ZU: 0.681–0.797; CZ: n.a.). Our method may provide a policy-relevant indicator of long-term provision, quality and access to OAT following first treatment.

New Patients in Treatment for Opioid Addiction in Spain

“…Regarding the characteristics of the study population, both user age and age of initiation of opioid consumption suggests that new users are beginning opioid use more than 5 years later than prior generations. 4,5,9 Finally, in terms of nationality, nearly 35% of NP was foreign-born, nearly double the percent among OP, and more than double the percent documented in recent studies. 10 Although the foreign-born population in Spain has increased in recent decades, it still represents less than 15% of the total Spanish population.…”

“…This corresponds to what has been described in other studies that indicate that a greater number of years of opioid use is associated with a weaker social network. 8,9 While heroin is the principal opioid of 94% of all users, the rate among NP is lower, at 84.5% (70.7% in women and 87.7% in men). During the years when this information was collected, there did not seem to be an upturn in opioid consumption in Spain.…”

“…This corresponds to what has been described in other studies that indicate that a greater number of years of opioid use is associated with a weaker social network. 8,9…”

Opioid maintenance treatment in the Czech Republic, Norway and Denmark: a study protocol of a comparative registry linkage study

“…26 Treatment participation (retention in treatment) improves outcomes of OMT, 27 28 while cycling in and out of OMT seems to be a common trajectory for many people with OUD. 29 However, OMT is not a static and well-defined treatment modality. The current evidence base consists of a wide variation in outcome measures of treatment of people with OUD, across time and settings, which reduces comparability of results.…”

“… 26 Treatment participation (retention in treatment) improves outcomes of OMT, 27 28 while cycling in and out of OMT seems to be a common trajectory for many people with OUD. 29 …”