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Type of opioid dependence among patients seeking opioid substitution treatment: Are there differences in background and severity of problems?
Jönköping University, School of Health and Welfare. County Hospital Ryhov, Department of Dependency, Psychiatric Clinic, Jönköping, Sweden.ORCID iD: 0000-0002-1749-4727
Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).ORCID iD: 0000-0002-8158-0486
2016 (English)In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 11, no 1, p. 1-8, article id 23Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Background: The study explores differences and similarities in background and problem severity among those seeking Opioid Substitution Treatment (OST), comparing those who primarily had misused "opiates", e.g. heroin, morphine and opium, with those who primarily had misused other opioids.

Methods: Patients (n=127) assessed for possible admittance in OST are compared based on the Addiction Severity Index. Two groups based on primary type of opioid misused are compared (opiates vs. other opioids).

Results: In the global severity ratings there were no significant differences between the groups other than tautological artefacts concerning heroin. There were few specific differences between the groups. The opiate group more often had Hepatitis C and more often had legal problems related to financing their misuse. Injection of drugs was the main method of administration in both groups, i.e. 90 % for mostly opiates vs. 75 % for mostly other opioids. A great majority in both groups, 96 % vs. 91 %, had misused most other types of drugs. Both groups were found to have severe problems in all areas investigated.

Conclusions: The study demonstrates great similarities in problem severity among those seeking OST, both those who primarily had misused opiates and those who primarily had misused other opioids.

Place, publisher, year, edition, pages
2016. Vol. 11, no 1, p. 1-8, article id 23
Keywords [en]
Opiates, Opioid Substitution Treatment, Opioid-related disorders, Opioids
National Category
Substance Abuse
Identifiers
URN: urn:nbn:se:hj:diva-31175DOI: 10.1186/s13011-016-0066-1ISI: 000379329800001PubMedID: 27401680Scopus ID: 2-s2.0-84979655919OAI: oai:DiVA.org:hj-31175DiVA, id: diva2:951213
Funder
Futurum - Academy for Health and Care, Jönköping County Council, Sweden, FUTURUM-342201Available from: 2016-08-08 Created: 2016-08-08 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

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