Improved Quality of Life, Clinical, and Psychosocial Outcomes Among Heroin-dependent Patients on Ambulatory Buprenorphine Maintenance

Abstract

Aim: A prospective longitudinal design was employed to examine the effects of buprenorphine maintenance on quality of life (QOL), clinical, and psychosocial characteristics of heroin-dependent patients. Method: Between 2003 and 2005 data were collected on 259 patients attending the outpatient centers for treatment of drug addictions across Israel, of which 157 were reevaluated 16 weeks later and 105 reevaluated 32 weeks later using the Clinical Global Impression, Distress Scale for Adverse Symptoms, Quality of Life Enjoyment and Satisfaction Questionnaire, General Health Questionnaire, General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support. Univariate and multivariate analyses were conducted to examine the association between the parameters and the cross-sectional and longitudinal predictions of the QOL outcomes. Results: The groups did not differ in baseline values and their post-treatment ratings revealed significant improvement on virtually all the scales. Perceived self-efficacy and social support from friends and significant others at baseline as well as their changes over time were the best predictors of the QOL in the short and long terms. The study's limitations are noted. Conclusions: The beneficial effects on the QOL were associated with improvement in the psychosocial parameters and a reduction in buprenorphine-related side effects and psychological distress. This study could stimulate research to compare the QOL related to buprenorphine and methadone treatment and serve as a basis on which a controlled study should be performed.

RÉSUMÉ

Une étude prospective et longitudinale a été élaborée afin d’évaluer les effets de la Buprenorphine en traitement de substitution sur la Qualité de vie (QOL), les caractéristiques cliniques et psychologiques des patients dependents a l’héroïne et traites dans les centres ambulatoires spécialises dans les addictions a travers tout Israël. Entre 2003 et 2005, 259 patients ont étés répertories dont 157 réévalues après 16 semaines de traitement; 105 après 32 semaines de traitement, par les méthodes d’impression cliniques globales, Echelles de la Détresse pour les symptômes secondaires, le questionnaire de satisfaction et qualité de vie, le questionnaire de santé général, le questionnaire général d’auto évaluation d’efficacité et l’échelle multidimensionnelle d’appui social. Des analyses à une variante et multi variantes ont été conduites pour examiner l’association entre les paramètres et les prédictions croisées et longitudinales des résultats QOL. Les bases de donnes dont identiques dans les différents groupes étudies et l’évaluation post traitement démontre une amélioration significative pratiquement sur toutes les échelles. L’auto évaluation d’efficacité et l’appui social d’amis ou autres personnes significative, aussi bien que leurs changements étaient les meilleures appréciations du QOL sur le court et long terme. Les limites de l’étude ont étés observés. Les effets positifs sur la qualité de vie ont été associés à l’amélioration des paramètres psychosociaux et une réduction des effets secondaires de la Buprenorphine liés et la détresse psychologique.

RÉSUMÉN

En el presente estudio se utilizo un diseno longitudinal para investigar los efectos del mantenimiento con buprenorfina sobre la calidad de vida (QOL) y caracteristicas clinicas y psico-sociales de pacientes dependientes de heroina que atienden los centros ambulatorios para tratamiento de toxico-dependencias en Israel. Entre los anos 2003 y 2005 se recaudaron datos acerca de 259 pacientes. Entre ellos 157 fueron reevaluados despues de 16 semanas y 105 despues de 32 semanas, utilizando los cuestionarios siguientes: Clinical Global Impression, Distress Scale for Adverse symptoms, Quality of Life Enjoyment and Satisfaction Questionnaire, General Health Questionnaire, General Self-Efficacy Scale and the Multidimensional Scale of Perceived Social Support. Analisis uni y multi-dimensionales se llevaron a cabo para estudiar la posible asociacion entre los parametros y las predicciones cross-sectional y longitudinales de los resultados del QOL. Los grupos no mostraron diferencias en la evaluacion de base y la evaluacion despues del tratamiento revelo mejoras significativas en todas las escalas. Percepcion de eficacia personal y apoyo social por parte de amigos y otras personas significativas en la primera evaluacionresultaron ser los mejores elementos de prediccion de calidad de vida a corto y largo plazos. Las limitaciones de este estudio fueron tomadas en cuenta y analizadas. Los efectos beneficos sobre la calidad de vida resultaron asociados a una mejoria en los parametros psico-sociales y a una reduccion de los efectos secundarios de la buprenorfina y el stress psicologico. Este studio podria estimular investigaciones que comparen la calidad de vida relacionada al tratamiento con buprenorphine y methadone y servir de base para comparer otrosl estudios controlados.

Keywords :

• buprenorphine
• ambulatory maintenance
• heroin dependence
• side effects
• quality of life
• emotional distress
• self-efficacy
• social support

Notes

1 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

2 Treatment can be briefly and usefully defined as a planned, goal directed change process, which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA,NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users- of whatever types- which aren't also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Editor's note.

3 The reader is reminded that substance users of what ever types of drugs used, patterns and manner of use, sites of use, meanings attributed to the substance, its use and the “drug experience”, etc. as well as “abstainers” represent a heterogeneous population and not a homogeneous at any given point in time, place and/or culture. Editor's note.

4 An inadvertent “suggestion” of actual or potential causal relationships can be considered using Hills's criteria for causation. These were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. (Hill, A. B. (1965). The environment and disease: associations or causation?? Proceedings of the Royal Society of Medicine 58: 295–300.). Editor's note.