Patients’ Perspectives on Coming Off Opioid Agonist Treatment: A Qualitative Study

Abstract

Aims: Opioid agonist treatment (OAT) programs are life-saving, as they reduce opioid use, overdoses, and criminal activities. Disadvantages reported with long-term OAT include side effects of the medication, especially on cognitive ability and sexual function, which may discourage potential participants. Many of those who participate in OAT have a desire to come off treatment. The aims of this study were to explore patients’ thoughts about coming off OAT and to investigate their perceptions of what support they would need in order to realize a planned withdrawal from OAT. Methods: A qualitative interview study with semi-structured interviews, using applied thematic analysis. Persons with experiences of participating in OAT were invited from Swedish programs and a private Facebook community. Results: Fifteen persons, with a mean of 9.6 (±6.4) years of treatment experience, were included. The participants underlined the need for a patient-centered focus within the treatment. They wanted to be regarded as capable of deciding if, when, and how a planned ending was to take place. They also called for staff to be supportive in making such decisions. Participants recommended staff to be sensitive to the needs of the specific patient and to have strategies for coming off OAT that could be adjusted for the single person. Conclusions: OAT programs need to be continually updated and adapted to the persons who can benefit from them. Applying a person-centered, holistic perspective would enhance the quality of the treatment by emanating from individual goals. Regulatory guidelines need to take into account research on patient experiences and perspectives on coming off.

What is the ideal time to begin tapering opioid agonist treatment? A protocol for a retrospective population-based comparative effectiveness study in British Columbia, Canada

“…Opioid use disorder (OUD) is a chronic recurrent illness1 affecting an estimated 26.8 million people, with an increase in prevalence of over 47.3% over the past 20 years worldwide 2. Although opioid agonist treatment (OAT) is intended as a long-term, potentially indefinite treatment for persons with OUD, many persons may have a strong desire to eventually taper off treatment 3. OAT tapering involves a gradual reduction in daily OAT dosing to ultimately reach a state of opioid abstinence 4.…”

“…Qualitative studies assessing clients’ perspectives on OAT tapers have indicated that many people with OUD have a desire to eventually discontinue their OAT and achieve a state of abstinence from opioids. A qualitative study of 15 participants in Sweden indicated that clients’ perspectives on tapers are dependent on their duration and response to treatment 3. People in the first 2 years of treatment are less likely to consider tapering off OAT as cravings can be reduced or avoided by receiving an appropriate dose of OAT 3.…”

“…A qualitative study of 15 participants in Sweden indicated that clients’ perspectives on tapers are dependent on their duration and response to treatment 3. People in the first 2 years of treatment are less likely to consider tapering off OAT as cravings can be reduced or avoided by receiving an appropriate dose of OAT 3. During OAT, over 90% of participants in the study desired independence from their reliance on medications and the regimented lifestyle required in their OAT programmes, noting inconveniences caused by the environment at the treatment centre, limited programme opening hours, side effects of medications and a strong desire of being drug-free 3 12 13.…”

“…People in the first 2 years of treatment are less likely to consider tapering off OAT as cravings can be reduced or avoided by receiving an appropriate dose of OAT 3. During OAT, over 90% of participants in the study desired independence from their reliance on medications and the regimented lifestyle required in their OAT programmes, noting inconveniences caused by the environment at the treatment centre, limited programme opening hours, side effects of medications and a strong desire of being drug-free 3 12 13. According to a cross-sectional study that surveyed 145 people receiving OAT at public clinics in Sydney, Australia, 62% of participants expressed a strong desire to gradually taper off OAT over the coming 6 months 14.…”

Patient reported goals for medications for opioid use disorder: A theory of proximal goal attainment

“… 23 Several models have been suggested to facilitate patient engagement, including shared decision making and using patient-reported goals (PRGs). 24 , 25 PRGs may have distinct advantages over traditional, provider-defined treatment goals, as provider-defined goals may oversimplify the complexities of managing care for a patient with OUD and may value aspects of the care differently from their patients. 26 , 27 , 28 However, complicating the issue is the fact that these patient goals likely shift as a patient moves from addiction through to the various stages of recovery.…”