scholarly journals The shifting roles of medical stakeholders in opioid substitution treatment: a comparison between Denmark and the UK

2015 ◽  
Vol 15 (4) ◽  
pp. 216-230 ◽  
Author(s):  
Bagga Bjerge ◽  
Karen Duke ◽  
Vibeke Asmussen Frank
Keyword(s):  
Medical Professionals ◽  
Substitution Treatment ◽  
Policy And Practice ◽  
Opioid Substitution Treatment ◽  
Content Type ◽  
Recovery Movement ◽  
Drug Policies ◽  
History Of ◽  
The Uk ◽  
Opioid Substitution

Purpose – The purpose of this paper is to examine the shifting roles of medical professionals as stakeholders in opioid substitution treatment (OST) policies and practices in Denmark and the UK within the past 15 years. Design/methodology/approach – The paper is based on literature reviews, documentary analyses and key informant interviews with a range of stakeholders involved in OST and policy in Denmark and UK. The study is part of the EU-funded project: Addictions and Lifestyles in Contemporary Europe: Reframing Addictions Project. Findings – Denmark and the UK are amongst those few European countries that have long traditions and elaborate systems for providing OST to heroin users. The UK has a history of dominance of medical professionals in drugs treatment, although this has been recently challenged by the recovery movement. In Denmark, a social problem approach has historically dominated the field, but a recent trend towards medicalisation can be traced. As in all kinds of policy changes, multiple factors are at play when shifts occur. We examine how both countries’ developments around drugs treatment policy and practice relate to broader societal, economic and political changes, how such divergent developments emerge and how medical professionals as stakeholders enhanced their roles as experts in the field through a variety of tactics, including the production and use of “evidence”, which became a key tool to promote specific stakeholder’s perspectives in these processes. Originality/value – The paper contributes to current policy and practice debates by providing comparative analyses of drug policies and examination of stakeholder influences on policy processes.

Personal social services for children and families in the UK: a historical review

2017 ◽  
Vol 12 (2-3) ◽  
pp. 72-84 ◽  
Author(s):  
Roger Bullock ◽  
Roy Parker
Keyword(s):  
Social Services ◽  
Design Methodology ◽  
Historical Review ◽  
Children And Families ◽  
Policy And Practice ◽  
Content Type ◽  
History Of ◽  
The Uk ◽  
Political Economic ◽  
The Impact

Purpose The purpose of this paper is to chart the history of personal social services for children and families in the UK and examine the factors that have influenced it. Special attention is given to changing perceptions of rights, the impact of scandals and the contribution of child development research. Design/methodology/approach Analysis of historical documents and research reports using four methods: a timeline of milestones, demarcation of distinct developmental periods, trends in policy and practice and comparisons of children’s needs and experiences at different times. Findings The evolution of services has not been linear. In policy, there have been reform and retrenchment, amalgamation and differentiation. Practice has been shaped by the emergence of new problems and the disappearance of old ones as well as by legislation, extreme events, research and finance, all occurring in specific political, moral and economic contexts. Originality/value An analysis of developments in children’s services in their political, economic, moral and research contexts.

Providing therapeutic community initiatives for individuals on opioid substitution treatment

2017 ◽  
Vol 38 (2) ◽  
pp. 79-86
Author(s):  
Carolyn Stubley ◽  
Garth Popple
Keyword(s):  
Therapeutic Community ◽  
Substitution Treatment ◽  
Completion Rates ◽  
Opioid Substitution Treatment ◽  
Community Initiatives ◽  
Content Type ◽  
Complex Needs ◽  
Research Findings ◽  
The Individual ◽  
Opioid Substitution

Purpose Developing therapeutic community (TC) programs in Australia for individuals on opioid substitution treatment (OST) has been a process spanning 16 years for the We Help Ourselves (WHOS) organization. Supported reduction of OST and stabilization services for those remaining on OST are offered to this population and continue to break down barriers of discrimination in offering the same services to all drug using populations. The paper aims to discuss these issues. Design/methodology/approach A number of research projects have been undertaken with the WHOS Opioid Treatment Program (OTP) TC services profiling clients accessing the services; looking at health benefits whilst in the programs; looking at retention and completion rates and conducting an evaluation post-treatment for one of the two programs currently being offered. Findings The excerpts from the research findings are presented identifying the complexity of individuals accessing WHOS services; highlighting the benefits for individuals on OST and assessing the effectiveness of the TC model for the client groups. Originality/value Working with multiple complex needs clients on OST in a residential TC environment offers many challenges and opportunity to work with an array of issues that present before during and after the residential stay. Provision of a history and overview of the WHOS OTP TC services and recent enhancements to these programs highlight a continuum of care for the individual on OST.

What stops people on long-term opioid substitution from completing treatment?

2017 ◽  
Vol 17 (4) ◽  
pp. 232-241
Author(s):  
Tatenda Kondoni ◽  
Christos Kouimtsidis
Keyword(s):  
Negative Impact ◽  
Service Users ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
Content Type ◽  
Face To Face ◽  
Treatment Providers ◽  
Medication Dose ◽  
Opioid Substitution

Purpose Opioid substitution treatment is effective in reducing harm for the person and society. However, the introduction of the recovery agenda has changed treatment philosophy. Associated targets such as successful treatment completions have introduced new expectations from treatment providers and service users. The purpose of this paper is to provide a service user-centred evaluation of underlying reasons that might prevent them from considering completion of treatment. Design/methodology/approach Ten service users who were stable on opioid substitution treatment for more than five years were interviewed face-to-face using a semi-structured format. Detailed inductive coding and thematic analysis of all transcripts was conducted. Findings Most participants expressed fear of change to their treatment and in particular reduction of the prescribed medication, due to past traumatic withdrawal experience, fear of relapse, fear of negative impact on their mental and physical health. Nevertheless all were optimistic about their future lives and were hoping to be able to complete their treatment at some point. A three-month follow-up revealed little change, with most participants not considering changing their medication dose in the future. Practical implications It could be argued that treatment providers, instead of focussing their efforts on stable service users in promoting treatment exit, should focus on new service users, avoiding coercion to treatment aims and rushed detoxifications. Originality/value This small qualitative study confirms results of other recent studies on the same theme and argues for the importance of the quality of the treatment experience of new people accessing treatment.

scholarly journals Patient Dropout from Opioid Substitution Treatment

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Opioid Dependence ◽  
Dropout Rate ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
Exact Test ◽  
Factors Associated ◽  
Patient Dropout ◽  
Key Indicator ◽  
History Of ◽  
Opioid Substitution

Opioid Substitution Treatment (OST) is an established treatment for opioid dependence. In New Zealand, OST programs are regulated by the Ministry of Health (2014) and Methadone and Buprenorphine/Naloxone (Suboxone) are the primary medications. Retention on OST is a key indicator for stabilisation of patients with opioid dependence. The purpose of the present research was to study dropout rates and identify factors associated with the dropout of patients from OST at the Community Alcohol and Drug Service (CADS), Hamilton, from 1st January 2013 to 30th April 2014. A retrospective clinical audit of patients on OST was conducted. There were 150 patients on OST in Hamilton under the CADS team during the period of study. Nine patients dropped out during the study period. Sixty-four patients were randomly selected from the remaining 141 patients who remained on treatment as a comparison group and for the study sample to be approximately half of the overall population of 150 patients. File review was conducted and potential predictors of dropout were identified. Thirty-five independent variables were selected and dropout was the dependent variable. The statistical programme SPSS22 was used to analyse the data. Fisher’s exact test was used and four variables were identified as being associated with dropout: history of intravenous drug use; (Fisher’s exact p = 0.05); history of lifetime imprisonment (Fisher’s exact p =0.05); other medications prescribed, (Fisher’s exact p = 0.04); and opioid type prescribed during the study, i.e. methadone or Suboxone. Patients on Suboxone dropped out more than those on methadone, (Fisher’s exact p = 0.00). The overall dropout rate was 6%, which was less than the rates of 15-85% found in previous studies. The limitations of the study were that it was retrospective and the number of dropouts was small. Furthermore, only patient factors associated with dropout were included in the study and service factors were not included.

scholarly journals Opioid substitution treatment uptake among people who inject drugs: The findings of two consecutive bio-behavioral surveillance surveys in Iran

2020 ◽  
Author(s):  
Mehran Nakhaeizadeh ◽  
Zahra Abdolahiniya ◽  
Hamid Sharifi ◽  
Ali Mirzazadeh ◽  
Mohammad Karamouzian ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Substitution Treatment ◽  
Urban Centers ◽  
Opioid Substitution Treatment ◽  
Behavioral Surveillance ◽  
Opioid Drugs ◽  
History Of ◽  
Opioid Substitution

Abstract Background Opioid substitution treatment (OST) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OST uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran. Methods Data were obtained from two national bio-behavioral surveillance surveys (N2010 = 1,783 and N2014 = 2,166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression model was used to determine the correlates of OST uptake for 2014 survey and adjusted odds ratios (AORs) and 95% confidence intervals (CI) were reported. Results The prevalence of OST uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P-value = 0.033). OST uptake varied across the studied cities ranging from 0.0%-69.3% in the 2010 survey and 3.2%-75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI: 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI: 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI: 1.08, 2.5) were associated with OST uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI: 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI: 0. 0.51, 0.86) were less likely to uptake OST. Conclusions Although OST uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remains significant disparities across urban centers in Iran. Importantly, the OST services appear to be serving high risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes of opioid substitution treatment across Iran.

scholarly journals Polluting pharmaceutical atmospheres: Compulsion, resistance, and symbolism of buprenorphine in Norway

2018 ◽  
Vol 36 (3) ◽  
pp. 267-285
Author(s):  
Aleksandra Bartoszko
Keyword(s):  
Social History ◽  
Opioid Substitution Treatment ◽  
Ethnographic Fieldwork ◽  
Ethnographic Studies ◽  
Counter Narrative ◽  
The Social ◽  
Institutional Forces ◽  
History Of ◽  
Insight Into ◽  
Opioid Substitution

This article offers a counter narrative to the current ethnographic studies on treatment with buprenorphine, in which notions of promised and experienced normality dominate. In some countries, introduction of buprenorphine led to a perceived “normalisation” of opioid substitution treatment, and this new modality was well received. However, in Norway the response has been almost the opposite: patients have reacted with feelings of disenfranchisement, failure, and mistrust. Based on ethnographic fieldwork in Norway, this article offers comparative insight into local experiences and subjectivities in the context of the globalisation of buprenorphine. By outlining the ethnographic description of the pharmaceutical atmosphere of forced transfers to buprenorphine-naloxone, I show that the social history of the medication is as significant as its pharmacological qualities for various treatment effects. An analysis of the reactions to this treatment modality highlights the reciprocal shaping of lived experiences and institutional forces surrounding pharmaceutical use in general and opioids in particular.

Sign in / Sign up

Export Citation Format

Share Document