Valuing methadone takeaway doses: The contribution of service-user perspectives to policy and practice

Abstract

Unlike health policy in the United Kingdom, Australian health policy does not provide a strong endorsement for the involvement of service users in the design, delivery and evaluation of drug treatment services. There has been no research into service-users' views on the contentious issue of methadone takeaway doses. This study explores the value of takeaway doses from service-users' perspectives and highlights the contributions that service-user involvement can make to further drug treatment planning, delivery and evaluation. Twenty-five methadone clients were interviewed about the value of methadone takeaway doses. Benefits cited by participants included convenience, less travel and lower costs, protection of confidentiality and less restriction on employment as well as less tangible issues related to feelings of 'normality' and flexibility in daily life patterns. Feeling trusted as a methadone client was also an important result of accessing takeaway doses. The inclusion of service-user perspectives is important for ensuring that services are not wrongly targeted and that evaluations of those services do not underestimate or misrepresent their value to clients. This is particularly important in policy around illicit drug use where public and political opinion is often a key driver in decision making.

Patient views of opioid pharmacotherapy biodelivery systems: Qualitative study to assist treatment decision making.

“…Berg et al, 2009;Eversman, 2010;Larance et al, 2011;Lin et al, 2010;Philbin & Zhang, 2010) and patient perspectives (e.g. Anstice et al, 2009;Conner & Rosen, 2008;Harris & McElrath, 2012;Lin et al, 2011;Nyamathi et al, 2007;Treloar et al, 2007).…”

Consumer satisfaction with opioid treatment services at community pharmacies in Australia

“…Drug treatment consumers often view themselves as undeserving of quality health services and this may be further compounded by stigma associated with drug use and drug treatment participation [3,27]. Many clients on methadone treatment are acutely aware of the differences between the treatment systems for methadone compared to other areas of medicine, particularly regarding supervised dosing [28].…”

“…Clients receiving treatment at a pharmacy pay a dispensing fee and have the opportunity to be provided with takeaway doses. The provision of treatment at a community pharmacy allows greater integration with the community and the provision of takeaway doses reduces the restrictions associated with frequent attendance for dosing, thus allowing more opportunities for employment, education and family responsibilities [3]. Typically, the role of community pharmacies is to provide supervised dosing to clients who have been stabilised at a clinic, and to provide feedback to prescribers before a new prescription is provided, or when problems arise.…”

“…In addition, the treatment experiences of community pharmacy clients have received some attention. Studies in the UK and Australia have explored client perceptions of treatment and issues relating to staff attitudes, privacy during supervised dosing, flexibility regarding takeaway dosing, the cost of treatment and being treated differently from other customers [3,[9][10][11][12][13]. A recent study of 432 clients receiving methadone and buprenorphine treatment at public clinics in NSW found that while clients were generally satisfied with treatment, they were dissatisfied with the frequency of clinic attendance for dosing, inflexible dosing hours, and a lack of takeaway doses [14].…”

The effect of an electronic medicine dispenser on diversion of buprenorphine-naloxone—experience from a medium-sized Finnish city

“…Retention in treatment is similar (Fiellin et al, 2006;Bell et al, 2007;Moore et al, 2012) or even improved (Holland et al, 2012) in comparison with observed dosing. OST patients value unobserved dosing and consider it as an essential part of OST (Stone & Fletcher, 2003;Treloar, Fraser, & Valentine, 2007;Madden, Lea, Bath, & Winstock, 2008).…”