Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Opiates versus other opioids – are these relevant as diagnostic categorizations?
Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Department of Dependence, Psychiatric Clinic, County Hospital Ryhov, Jönköping, Sweden.ORCID iD: 0000-0002-1749-4727
Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).ORCID iD: 0000-0002-8158-0486
2017 (English)In: Heroin Addiction and Related Clinical Problems, ISSN 1592-1638, Vol. 19, no 6, p. 39-48Article in journal (Refereed) Published
Abstract [en]

Background:

For more than three decades, the international diagnostic systems have used the term ‘opioids’, including opiates, yet research publications continue to use an older terminology. In 2010, new Codes of Statutes for “opiate replacement therapy” (ORT) was brought into effect in Sweden, stating that only those “dependent on opiates” – explicitly described as heroin, morphine or opium – were eligible. Those addicted to other opioids were then denied access. This study examines the relevance of the distinction of opiates vs. other opioids. Are there differences in the severity of opioid dependence or concerning other substance-related diagnoses?

Methods:

Ninety-nine individuals participated: 1) the opiate group (n = 69), and 2) the other opioids group (n=30). Structured interviews covered the ICD-10 criteria of nine different types of addictive substances. For opioids, questions were asked separately in relation to opiates versus other opioids.

Results:

The two groups fulfilled the criteria for opioid dependence to the same extent, with most participants meeting all six criteria, so indicating a severe opioid dependence problem. Both opiates and other opioids had contributed to their development of opioid dependence, and both groups, to the same high degree, showed comorbidity affecting other dependence conditions.

Conclusions:

This study reveals that the two categories of opioids used contribute to the development of opioid dependence and that the term ‘opioids’ can be suitably used to convey a unitary concept in diagnostic terms. There was no support for treating the two groups differently. The study calls for more stringent use of terminology in accordance with the international diagnostic systems.

Place, publisher, year, edition, pages
Associazione per l'Utilizzo delle Conoscenze Neuroscientifiche a fini Sociali , 2017. Vol. 19, no 6, p. 39-48
Keywords [en]
Maintenance treatment; Buprenorphine; opioid; opiate; dependence; diagnosis; nosology
National Category
Substance Abuse Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:hj:diva-37848ISI: 000416893800005Scopus ID: 2-s2.0-85035240103OAI: oai:DiVA.org:hj-37848DiVA, id: diva2:1155750
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-04-10Bibliographically approved
In thesis
1. En dyster parentes – opiatregeln i svensk LARO-behandling 2010–2016
Open this publication in new window or tab >>En dyster parentes – opiatregeln i svensk LARO-behandling 2010–2016
2019 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
A dismal parenthesis – The opiate rule in Swedish opioid maintenance treatment 2010–2016
Abstract [en]

Opioids are well documented to arouse euphoria, relieve pain, and to have a high dependency potential. Opioid dependence is a serious chronic condition with a high risk of extensive worsened health, relapse and premature death.

Opioid maintenance treatment (OMT) is well researched and has strong scientific support. In Sweden, OMT over time was subjected to polarised and infected political debate and has been strictly regulated by the National Board of Health and Welfare (NBHW). During 2010–2016 NBHW redefined the diagnostic concept of “opiate dependence” in the regulation SOSFS 2009:27. Dependence to only three opioids: heroin, opium or morphine, could give eligibility to OMT (here called the “opiate rule”). The purpose stated was to prevent those dependent to other opioides, e.g. buprenorphine,from receiving OMT. Applicants with severe opioid dependence were thereby divided into two subgroups: those with “opiate” dependence related to heroin, morphine or opium, and those with opioid dependence who lacked documentation in relation to the three opiates. The question is whether there were differences between these groups concerning problem severity or substance-related diagnostics that could justify differences in access to OMT?

A population (n = 127) actualised for OMT during 2005-2011 in Jönköping County is studied regarding severity of problems, diagnostics and trajectories in and out of treatment. In order to provide precise drug use data, a cognitive tool for taking anamnestic information, called the Drug List, was developed.

In Study I, using the Addiction Severity Index, the two groups were found to be quite similar in severity of health problems, social situation and drug problems, including overdoses and injections.

In Study II, the Drug List was found to be superior to a traditional way of taking anamnestic data, more sensitive and giving more precise data, without taking more time. Validity was shown in relation to faked drugs.

In Study III, using a structured diagnostic interview, ADDIS, with the Drug List, showed that both two groups qualified for severe opioid dependence, that opiates and other opioids had contributed equally to the development of opioid dependency, and that the two groups also had similar additional substance dependence problems.

Study IV investigated how “the opiate rule” affected practice by interviewing representatives of OMT clinics as well as a representative of a users’ association. The regulation created dilemmas for clinics as well as for users. Users developed a strategy of getting "negative merits" for being eligible to OMT. Clinicians developed strategies to find ways “around” the regulation in order to admit patients in OMT.

Study V followed those who had applied for OMT and found four trajectory subgroups – those denied OMT, those discharged, those readmitted, and those who remained in treatment. The study provides evidence for a more positive development being related to more involvment in OMT concerning health, social situation as well as substance use problems. Being denied or discharged is related to increased risks of a negative development.

The thesis conclude that there was no support for dividing applicants according to “the opiate rule”. The purpose of top-down control using regulations, is to guarantee uniform and knowledge-based care. In this case the regulation had negative effects in these respects, increasing risks for the applicants, and lost credibility from the profession. The opiate rule in SOSFS 2009:27 is therefore a dismal parenthesis in the history of OMT in Sweden, and could be studied to prevent similar mistakes in the future.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2019. p. 152
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 095
Keywords
opiates, opioids, opioid maintenance treatment, methadone, buprenorphine, regulation, National Board of Health and Welfare, opiater, opioider, opioidberoende, buprenorfin, metadon, läkemedelsassisterad behandling, föreskrift, Socialstyrelsen
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-43443 (URN)978-91-85835-94-2 (ISBN)
Public defence
2019-05-10, Forum Humanum, Hälsohögskolan, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved

Open Access in DiVA

Fulltext(188 kB)68 downloads
File information
File name FULLTEXT01.pdfFile size 188 kBChecksum SHA-512
d8533db792eb6d8a2da93c3f83c1b4bc6ee218bf955befe04396a8dbd8b8e5cb519b471bca556702d84121aca8fc9d4167f48ddc791cef83851b0cc0372cc253
Type fulltextMimetype application/pdf

Scopus

Search in DiVA

By author/editor
Monwell, BodilGerdner, Arne
By organisation
HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue)HHJ, Dep. of Social Work
In the same journal
Heroin Addiction and Related Clinical Problems
Substance AbusePharmacology and Toxicology

Search outside of DiVA

GoogleGoogle Scholar
Total: 68 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

urn-nbn

Altmetric score

urn-nbn
Total: 387 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf