Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys

Abstract

(1) The harm-reduction benefits of opioid agonist treatment (OAT) are well-established; however, the UK government’s emphasis on “recovery” may be contributing to a high proportion of people leaving treatment and low retention rates. We wanted to develop a rich and nuanced understanding of the factors that might influence the treatment journeys of people who use OAT. (2) We explored factors at each level of the socioecological system and considered the ways these interact to influence treatment journeys in OAT. We carried out semi-structured interviews with people who use OAT (n = 12) and service providers (n = 13) and analysed data using reflexive thematic analysis. (3) We developed three themes representing participant perceptions of treatment journeys in OAT. These were: (1) The System is Broken; (2) Power Struggles; and (3) Filling the Void. (4) Conclusions: The data suggest that prioritisation of treatment retention is important to preserve the harm-reduction benefits of OAT. Stigma is a systemic issue which presents multiple barriers to people who use OAT living fulfilling lives. There is an urgent need to develop targeted interventions to address stigma towards people who use OAT.

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

“…While many were clear that several clinic rules were frustrating and negative, a widespread theme was still that HAT was experienced as much better than traditional OAT, because the HAT rules were perceived as more laxed and involving less sanctions (see also [ 37 , 38 ]). However, HAT still involves a set of rules and potential sanctions that regulates the patients’ behavior in the clinic.…”

“…Karl echoes several participants when saying: “I had expected it to be something more, like, than just coming here for a shot, kind of.” He continued: “It would have been good to have something to do during the days. It’s of course possible to continue as before, going downtown pushing drugs… that’s an option too.” Obviously, getting more free time does not automatically influence positively on recovery processes [ 38 ].…”

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

“…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 ].…”

Stigmatized attitudes of medical staff toward people who use drugs and their determinants in Japanese medical facilities specialized in addiction treatment

“…Studies have indicated that healthcare professionals often undervalue the needs of PWUD compared to individuals with other psychiatric conditions, resulting in a disparity in the quality of care provided. 9,[17][18][19][20][21] PWUD frequently fear the potential repercussions of disclosing their drug use status, such as being reported to law enforcement. Consequently, they tend to conceal their condition.…”

“…Moreover, PWUD face additional stigma within healthcare settings when seeking formal support. Studies have indicated that healthcare professionals often undervalue the needs of PWUD compared to individuals with other psychiatric conditions, resulting in a disparity in the quality of care provided 9,17–21 . PWUD frequently fear the potential repercussions of disclosing their drug use status, such as being reported to law enforcement.…”