Patients’ Perceptions of Opioid Replacement Therapy: a Comparison of Diamorphine and Methadone/Levomethadone

Abstract

Diamorphine was first legalized as a novel treatment option for heroin dependence in Germany in 2009. Today, specialized clinics in ten German cities provide diamorphine to heavily addicted patients. As the medical and societal context of diamorphineassisted therapy is evolving, continued research into patients' perceptions of opioid replacement therapy remains important. From February 2018 to June 2018, we conducted a survey study of outpatients on maintenance treatment with either diamorphine (n=85) or methadone/levomethadone (n=126). Patients were asked to complete a self-report questionnaire querying, besides socio-demographic information, the study participant's satisfaction with the substitute drug, relapse with illicit drugs, patterns of craving, and alcohol consumption. Duration of opioid dependence did not differ significantly between groups. Patients on diamorphine were approximately three years younger than patients on methadone / levomethadone. They had a higher frequency of daily drug intake and had had their dosage adjusted more often during the preceding six months. Still, diamorphine patients reported greater satisfaction with their substitute drug in tandem with significant reductions in relapse-related behaviors and cravings. While the most common relapse reported by patients on methadone replacement was heroin relapse (68%), most instances of illicit drug use in the diamorphine group involved cocaine (48%). Although self-reported alcohol consumption did not differ significantly between groups, a higher percentage of diamorphine patients than methadone patients endorsed decreased alcohol consumption since entering therapy. Taken together, these findings point to meaningful differences between diamorphine and methadone / levomethadone in opioid

Quality of Life in Opioid Replacement Therapy: A Naturalistic Cross-Sectional Comparison of Methadone/Levomethadone, Buprenorphine, and Diamorphine Patients

“…Although no conclusions can be drawn about the causal direction of the correlation, it is still evident that there is a mutual influence on QoL and important treatment parameters, such as patients' high-risk co-use of illegal substances and alcohol consumption in opioid replacement therapy. In a comparative study on patients' opioid replacement treatment perception, it was found that patients under diamorphine therapy constated co-using illicit drugs less and experience less craving than patients under methadone treatment [48]. As one of the most prominent substitution therapy goals, reducing health-endangering co-consumption of illicit substances ideally leads to a prognostically favorable course of therapy.…”

The switching process from buprenorphine sublingual tablets to the monthly buprenorphine subcutaneous depot injection in opioid dependent patients

“…Physical well‐being was surveyed by means of the self‐evaluation questionnaire FAW (Questionnaire about the current physical well‐being) with 49 items (5‐level‐likert scale for answer options) 23 . Three items about the perceived craving experience were asked with the questionnaire BSCS (Brief Substance Craving Scale), 24 treatment satisfaction (five items, 5‐level‐likert scale) and co‐use of additional substances (four items, 5‐level‐likert scale) while treatment were surveyed by the self‐evaluation questionnaire ‘PORT’ 25 …”

“…23 Three items about the perceived craving experience were asked with the questionnaire BSCS (Brief Substance Craving Scale), 24 treatment satisfaction (five items, 5-level-likert scale) and co-use of additional substances (four items, 5-level-likert scale) while treatment were surveyed by the self-evaluation questionnaire 'PORT'. 25…”