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.

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.

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 The Impact of Misuse and Diversion of Opioid Substitution Treatment Medicines: Evidence Review and Expert Consensus

2015 ◽  
Vol 22 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Jens Reimer ◽  
Nat Wright ◽  
Lorenzo Somaini ◽  
Carlos Roncero ◽  
Icro Maremmani ◽  
...  
Keyword(s):  
Criminal Behavior ◽  
Opioid Dependence ◽  
Direct Impact ◽  
Substitution Treatment ◽  
Negative Effects ◽  
Opioid Substitution Treatment ◽  
Controlled Drugs ◽  
The Individual ◽  
The Impact ◽  
Opioid Substitution

Background/Aims: Opioid substitution treatment (OST) improves outcomes in opioid dependence. However, controlled drugs used in treatment may be misused or diverted, resulting in negative treatment outcomes. This review defines a framework to assess the impact of misuse and diversion. Methods: A systematic review of published studies of misuse and diversion of OST medicines was completed; this evidence was paired with expert real-world experience to better understand the impact of misuse and diversion on the individual and on society. Results: Direct impact to the individual includes failure to progress in recovery and negative effects on health (overdose, health risks associated with injecting behaviour). Diversion of OST has impacts on a community that is beyond the intended OST recipient. The direct impact includes risk to others (unsupervised use; unintended exposure of children to diverted medication) and drug-related criminal behavior. The indirect impact includes the economic costs of untreated opioid dependence, crime and loss of productivity. Conclusion: While treatment for opioid dependence is essential and must be supported, it is vital to reduce misuse and diversion while ensuring the best possible care. Understanding the impact of OST misuse and diversion is key to defining strategies to address these issues.

scholarly journals Addiction service changes due to COVID-19

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S349-S349
Author(s):  
Shumaila Shahbaz ◽  
Zeeshan Hashmani ◽  
Soraya Mayet
Keyword(s):  
Opioid Dependence ◽  
Data Retrieval ◽  
Service Evaluation ◽  
Individual Risk ◽  
Attendance Rates ◽  
Opioid Substitution Treatment ◽  
Face To Face ◽  
Addiction Service ◽  
The Individual ◽  
Opioid Substitution

AimsAddictions services had to respond rapidly to reduce COVID-19 transmission to protect patients and staff. Patients with opioid dependence are particularly vulnerable, with high risks. Our community addiction service changed practice in line with COVID-19 guidelines. For patients with opioid dependence; face-to-face contacts were initially reduce and mainly for new starts, restarts and non-attenders. Prescribing changes were completed on an individually risk assessed basis to reduce attendance at the chemist, specifically to reduce transmission, keep patients in treatment and to ensure chemists could continue to function. We document some of the service changes during the COVID-19 lockdown.MethodService evaluation had approval from Humber Teaching NHS Foundation Trust. Data retrieved on one Hub of a community addictions service in North England, UK. Patients prescribed opioid substitution treatment for opioid dependence were assessed, with data retrieval through electronic healthcare records. Data were analysed by Microsoft Excel anonymously.ResultIn lockdown (March 2020 to June 2020), we identified 112 patients with opioid dependence prescribed opioid substitution (OST) with methadone or buprenorphine at the Hub. All white British, mean 42 years, most male (75%) and prescribed methadone (78%). Ten were new starts and 8 restarts to OST. Attendance rates did not change: 91% before and 92% during lockdown. Appointment format changed from predominantly face-to-face (92%) to telephone (99%). Most patients (91%;n = 88) were offered take-home naloxone and overdose prevention training of which 14 refused. Supervision days at the chemist for OST reduced significantly from 75% collecting daily at the chemist, reducing to 20% during lockdown. Five patients were shielding and 7 had covid-related symptoms. There was one death during lockdown which was not attributed to covid or overdose.ConclusionThe addictions service continued to be open and work proactively throughout lockdown, seeing new patients and continuing treatment interventions safely. Major changes were made in line with COVID-19 guidelines, to respond to the threat of transmission. Our service was flexible and able to adapt quickly to remote working. We maintained excellent attendance rates despite changes to the format of consultations. There were no related incidents e.g. overdoses linked to prescribed medications, despite a reduction in supervision, and therefore patients having extra medications. This important finding may be related to the individual risk assessments that we conducted before making changing to prescribing. This was supported by most patients were receiving naloxone to prevent overdoses. Some of the changes, such as telephone consultations, may be beneficial to continue post COVID-19.

Sign in / Sign up

Export Citation Format

Share Document