Opioid maintenance treatment: trajectories in and out of treatment

Abstract

Problem: Although efficacy studies of opioid maintenance treatment (OMT) have shown evidence of treatment benefits, there is still need for studies on its effectiveness in natural clinical processes. This study investigates the development in health, substance use and social conditions of those who applied for OMT, including those denied access or discharged.

Method: First, persons assessed for admittance in 2005–2011 (n = 127) were categorized into four trajectory groups based on whether they were admitted or denied (n = 19), discharged (n = 31), readmitted (n = 21) or had been undergoing OMT without interruption (n = 56). Second, 99 of these, the analytical sample, were interviewed at follow-up using (a) the Addiction Severity Index (ASI) for seven problem-areas and housing, and (b) self-rated change in 11 problem areas. The ASI was compared to baseline interviews after 55 months (mean). Third, outcomes within groups was studied in relation to alternative interventions.

Results: Within the analytical sample, those denied OMT showed no improvements at group level, those discharged had some improvements, more if readmitted than if not and those with uninterrupted OMT showed the most comprehensive improvements. Those outside OMT, denied and discharged, had considerable mortality risks related to ongoing drug use, especially in lack of well-planned alternative interventions.

Conclusion: Improvements strongly relate to access to OMT. This study underscores that access to OMT improves the situation in all areas investigated and decreases the risk for drug-related death. It underscores the importance of two major risk situations, i.e. being denied OMT and being discharged.

Keywords:

• Opioid maintenance treatment
• drop-outs
• treatment outcome
• treatment process

Acknowledgments

We would like to acknowledge the invaluable help rendered by those interviewed, who spent time participating in this study without immediate benefit to themselves. We also want to thank PhD Mats Nilsson, Futurum – Academy for Health and Care, Jönköping County Council – for introducing us in Svensson’s method, and colleagues at the Dependency Clinic at County hospital Ryhov in Jönköping and at The National Board of Forensic Medicine in Linköping for their help and support.

Disclosure statement

None of the authors have interests related to this project other than research.

Additional information

Funding

The study was financed by a grant from FUTURUM, County Hospital Ryhov Jönköping [D.nr: FUTURUM-342201].