CANADIAN ILLICIT OPIATE USERS’ VIEWS ON METHADONE AND OTHER OPIATE PRESCRIPTION TREATMENT: AN EXPLORATORY QUALITATIVE STUDY

Abstract

Although methadone treatment has been available in North America for decades, only a small proportion of opiate addicts (some 25% of estimated opiate users in Canada) are receiving methadone treatment. Many users have tried methadone treatment, often multiple times, but leave treatment prematurely. Others would not consider it as a worthwhile treatment option for themselves. This exploratory study examines regular opiate users’ attitudes towards and experiences with methadone treatment in Canada, primarily setting out to determine what makes methadone an unsuccessful or even an undesirable treatment option for considerably large groups of opiate users. This empirical effort to explore the limitations of existing methadone treatment comes at an appropriate time, when alternative forms of opiate pharmacotherapy treatment are being proposed in Canada as complementary modes of intervention that hope to address the shortcomings of methadone treatment. The rationale for this study were feasibility questions and development efforts for a clinical trial in North America evaluating the effectiveness of using injectable opioids (heroin, dilaudid) in attracting and engaging treatment-resistant opiate users into treatment. Data for this exploratory qualitative study was collected in 1999 through a series of focus groups involving 47 treatment-experienced and treatment-naive opiate users in Vancouver, Montreal, and Toronto, with the objective of identifying key themes and issues on the described topic as a basis for further systematic research.

• Opiate addiction
• Treatment
• Heroin prescription
• User views
• Qualitative research

RESUMEN

Aunnque los tratamientos de methadona han sido convenientes en el norte de america por decadas, solamente una pequeña proporcion de adictos a opiaceos a8solamente el 20% de usarios a opiaceos en canada), estan recibiendo tratamientos con metadona, muchos usarios han probado el tratamiento con methadona eran reiteramdamente, pero lo han abandonado prematuramente con opcion. Otros no lo consideraron de gran valor aun para si mismos. Estos estudios exploratorios en la experiencia con methadona en canada, se trato de determinar porque el tratamiento con methadona no tuvo tanto exito o la opcion no deseada para un gran numero de usuarios de opio. Este esfuerzo empirico de explorar las limitaciones o exigencia de los tratamientos de methadona llegan a un apropiado tiempo, donde formas alternativas de farmacoterapia opiacea, han empezado como propuesta en canada, como modos complementarios de intervencion destinados como esperanzas de encontrar el tratamiento de methadona. El estudio, son preguntas viables, el esfuerzo para un ensayo clinico en el norte de america, evaluando su efectividad del usuario de opiodes inyectables (heroina, dilaudio), en atractivos y comprometidos tratamientos resistentes a usuarios de opiaceos dentro del tratamiento. Datos de exploraciones y estudios cualitativos estuvieri colectados a traves de focos de grupos envueltos en 47 tratamientos, experimentados ye ingenuos usuarios de opiaceos de vancover, montreal y toronto, con el objetivo de identificar la llave, motivo y uso de la descripcion topica, con una base para ulteriores investigaciones.

RÉSUMÉ

Bien que le traitement à la méthadone soit disponible en Amérique du Nord depuis des décennies, seulement une faible proportion de la population des consommateurs d’opiacés (quelque 20% des consommateurs d’opiacés estimés au Canada) bénéficient du traitement à la méthadone. Plusieurs consommateurs d’opiacés ont essayé la méthadone, souvent à plusieurs reprises, mais ils arrêtent prématurément le traitement. Certains autres ne considèrent pas ce traitement comme une option avantageuse. Cette étude exploratoire examine les attitudes et les expériences des consommateurs réguliers d’opiacés quant au traitement à la méthadone au Canada. Dans le but de déterminer ce qui rend le traitement à la méthadone une option indésirable et inefficace pour plusieurs de ces consommateurs, cette étude empirique explore les limites du traitement à la méthadone. Cette étude naît à un moment opportun, alors que des traitements alternatifs reliés à la dépendance aux opiacés surgissent au Canada en tant qu’interventions complémentaires aux limites du traitement à la méthadone. Le fondement de cette étude survient suite à des questions de faisabilité et à des efforts de développement lors d’un essai clinique en Amérique du Nord qui va évaluer l’efficacité d’utiliser des opiacés injectables (héroïne, dilaudid) afin d’attirer et d’intégrer à un programme de traitement les consommateurs d’opiacés autrefois résistants. Cette étude qualitative présente un corpus empirique dérivé d’une série de discussions (〈〈focus groups〉〉) avec 47 consommateurs d’opiacés (expérimentés ou naïfs au traitement à la méthadone) à Vancouver, Montréal et Toronto, dans le but d’identifier des questions et des thèmes sur le sujet afin d’élaborer des futures pistes de recherche.

Additional information

Notes on contributors

Benedikt Fischer

Benedikt Fischer, Ph.D., is Assistant Professor, Public Health Sciences and Criminology, University of Toronto, and Research Scientist at the Centre for Addiction and Mental Health in Toronto, Canada. His main research interests are international drug law and policy, social harms/costs and treatment of illicit drug use, and criminal justice studies. He currently leads the development of an interdisciplinary health research team on illicit opiate addiction in Canada and is a member of the Editorial Board of Substance Use and Misuse.

Adrienne T. Chin

Adrienne T. Chin holds a B.A. in Psychology from York University, Toronto. She contributed to the study on which the article is based in her then capacity as a Research Assistant at the Centre for Addiction and Mental Health, Toronto. She is currently pursuing an MHSc Degree in Health Promotion at the Department of Public Health Sciences, University of Toronto.

Irene Kuo

Irene Kuo holds an MPH from Johns Hopkins School of Public Health, Baltimore (U.S.) where she is currently also a doctoral student in the Department of Epidemiology, Infectious Diseases. Her areas of interest include infectious diseases among injection drug users and drug-treatment evaluation. Currently, she is evaluating a program referring Needle Exchange Program attenders into a mobile drug-user treatment program.

Maritt Kirst

Maritt Kirst, M.A., received her graduate degree in Criminology from the University of Ottawa, Canada. She currently works as a Research Associate in the Social, Prevention and Health Policy Research Department at the Centre for Addiction and Mental Health in Toronto, Canada. Her main involvement is in the development of an interdisciplinary social, clinical, and basic science research program on illicit opiate addiction in Canada.

David Vlahov

David Vlahov, Ph.D., is Director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine, and Professor of Epidemiology at the Johns Hopkins School of Public Health. He is recipient of a MERIT Award from the National Institutes of Health for his longitudinal study of HIV infection among injection drug users (the ALIVE study), and he is conducting studies in both Baltimore and Harlem, New York on drug users.