Patients’ satisfaction with heroin-assisted treatment: a qualitative study

Abstract

Background Heroin-assisted treatment (HAT) involves supervised dispensing of medical heroin (diacetylmorphine) for people with opioid use disorder. Clinical evidence has demonstrated the effectiveness of HAT, but little is known about the self-reported satisfaction among the patients who receive this treatment. This study presents the first empirical findings about the patients’ experiences of, and satisfaction with, HAT in the Norwegian context. Methods Qualitative in-depth interviews with 26 patients in HAT were carried out one to two months after their enrollment. Analysis sought to identify the main benefits and challenges that the research participants experienced with this treatment. An inductive thematic analysis was conducted to identify the main areas of benefits and challenges. The benefits were weighed against the challenges in order to assess the participants’ overall level of treatment satisfaction. Results Analysis identified three different areas of experienced benefits and three areas of challenges of being in this treatment. It outlines how the participants’ everyday lives are impacted by being in the treatment and how this, respectively, results from the treatment’s medical, relational, or configurational dimensions. We found an overall high level of treatment satisfaction among the participants. The identification of experienced challenges reveals factors that reduce satisfaction and thus may hinder treatment retention and positive treatment outcomes. Conclusions The study demonstrates a novel approach to qualitatively investigate patients’ treatment satisfaction across different treatment dimensions. The findings have implications for clinical practice by pointing out key factors that inhibit and facilitate patients’ satisfaction with HAT. The identified importance of the socio-environmental factors and relational aspect of the treatment has further implications for the provision of opioid agonist treatment in general.

Supervised on-site dosing in injectable opioid agonist treatment-considering the patient perspective. Findings from a cross-sectional interview study in two German cities

“…We found that daily visits in iOAT are not experienced uniformly. Daily visits gave a sense of structure and normalcy for some participants, particularly when compared to previous experiences with unstable OAT and illicit drug use [ 33 , 35 , 51 , 52 ]. Additionally, some participants felt as though “keeping busy” and being subjected to external control measures contributed to reaching their goal of abstinence [ 34 ].…”

“…Furthermore, strict dosing policies have been described as a means of exerting social control [ 26 – 28 ] and can contribute to the stigmatisation of people receiving OAT [ 29 – 32 ]. On the other hand, daily visits can provide stability and regular access to medical assistance [ 33 ], fill “the void” left by ceasing to use street drugs [ 34 ], and contribute to both the patients' “re-socialisation” [ 35 ] and the formation of a supportive community within OAT-clinics [ 36 ]. Additionally, the regular contact with clinic staff might enhance the “therapeutic alliance” [ 37 ] and positively contribute to the psychosocial components of iOAT [ 19 , 38 ], particularly when staff have an accepting approach to supervised injecting [ 39 ].…”

“…Considering these diverging effects, it comes as little surprise that the acceptability of supervised, on-site OAT is context-dependent and highly variable among patients in both oOAT [ 40 ] and iOAT [ 33 , 38 , 41 ]. Generally, daily attendance is less challenging when OAT is provided in a non-stigmatising setting which is conveniently located (e.g., close to patients' home or workplace), has extended service hours, and provides efficient services [ 42 , 43 ].…”

Exploring Patients’ Perceptions on Injectable Opioid Agonist Treatment: Influences on Treatment Initiation and Implications for Practice

“…However, individuals often initiate iOAT particularly because they were not satisfied in oOAT. This questions whether supplementing iOAT with oral substitutes can sufficiently address the negative perceptions related to repeated visits to the clinic and requires practical solutions, e.g., regarding take-home arrangements and flexible dosing policies [40, 41]. This could also assist in combating the negative perception of “having no life anymore” and insufficient engagement in society when in iOAT.…”

Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs

“…HAT participants in Denmark are subject to strict controls, especially with regards to scheduling and appointment attendance. In fact, there are criticisms of these programs by service users in other settings as being overly restrictive and not user-friendly, leading programs which are not running at capacity, despite the provision of legal heroin (Ellefsen et al, 2023). In 2011, an unsanctioned, mobile SCS began operation, being run by local NGOs in Copenhagen.…”