Beliefs About Methadone in an Inner-City Methadone Clinic

Stancliff, Sharon

doi:10.1093/jurban/79.4.571

Cited by 87 publications

(74 citation statements)

References 13 publications

(20 reference statements)

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“…Various studies have illuminated patients' subjective experiences and discontent with MMT. Key issues include the pharmacologic properties and physical-emotional side effects of methadone, the absence of injecting, dosing, and (or) take-home restrictions, and the overall treatment requirements (92)(93)(94). Despite highly prevalent polydrug use among illicit opioid users, MMT does not offer therapeutic value for nonopioid drug dependence; nevertheless, MMT patients are typically expected to reduce or quit their use of these substances.…”

Section: Treatmentmentioning

confidence: 99%

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

2006

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Clinical Implications • Illicit opioid use to a large extent manifests via the illicit use of prescription opioids and typically includes polysubstance use. • Physical and (or) mental health comorbidities are highly prevalent in illicit opioid user populations. • Morbidity and (or) mortality risks are often associated with social marginalization. Limitations • Little is known about the patterns and consequences of illicit opioid use in general populations. • Owing to the marginalized and illegal status of illicit opioid users, information is available only from selective populations with limited potential for generalizability of data. • The OPICAN study specifically builds largely on self-report and may be subject to bias. Objectives: To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). Method: We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n = 679) was collected in 2002. Results: Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine-crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in crime. Conclusions: Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.

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Section: Treatmentmentioning

confidence: 99%

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

2006

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“…24 Numerous other studies have confirmed the persistence of negative attitudes towards methadone and their impact on treatment recruitment and retention. 11,12,[25][26][27][28][29] Research has also shown that patients taking methadone are often hesitant to inform family members, employers, and physicians of their enrollment in treatment due to perceived stigma. 30 Such stigma and negative beliefs about methadone can lead to underutilization of a highly effective treatment modality.…”

Section: Discussionmentioning

confidence: 99%

“…32 The current study is also consistent with past research showing that methadone is often perceived by its target population as having significant negative health consequences. 11,12,[23][24][25][26][27][28][29] Interestingly, patients with prior methadone treatment experience held more negative views towards methadone on some measures. Due to their limited access to resources and information, this patient sample may have been less able to dispel common methadone stereotypes and challenge the prevailing street narrative than a more affluent population might have.…”

Section: Discussionmentioning

confidence: 99%

Patient Perspectives on Choosing Buprenorphine Over Methadone in an Urban, Equal-Access System

Gryczynski

Jaffe²,

Schwartz

et al. 2013

Am J Addict

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“…However, there is an increasing recognition that these constitute essential measures of MAT quality (Tiffany et al, 2012;Trujols et al, 2011;Uchtenhagen, 2015). Few studies have investigated subjective views of MAT episodes (Montagne, 2002;Stancliff, 2002), and, if so, mostly addressed patient satisfaction (Kelly et al, 2010;Marchand et al, 2011;Trujols et al, 2012). Fewer studies still have investigated the views of treatment providers (Becker and Fiellin, 2006).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of medication-assisted treatment of opioid dependence—The physicians’ perspective

Vogel

Nordt

Dürsteler

et al. 2016

Drug and Alcohol Dependence

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BACKGROUND: There is controversy about which outcome parameters should be employed to assess substance use treatment. Subjective measures of medication-assisted treatment (MAT) of opioid dependence are increasingly important. However, while patients' perspectives have been examined, the caregivers' views remain largely unknown. Here, we explore how physicians evaluate MAT, and which predictors are most relevant. METHODS: We conducted a retrospective cohort study of all MAT episodes with oral opioid agonists in the canton of Zurich between 1998 and 2013 using a case register. Termination forms of the register include a physician-completed assessment on the course of the treatment episode. Mixed model analysis was applied to determine relevant predictors. RESULTS: The analysis was based on 17,234 episodes from 7432 patients. Mean global assessment of the course of MAT was 'moderate'. The most important predictors for treatment evaluation by physicians were treatment break off as reason for termination (p<0.0001), psychological improvement throughout treatment (p<0.0001), wish for abstinence from the substitute (p<0.0001), social integration index at termination (p<0.0001), and social (p<0.0001) as well as medical (p<0.0001) improvement. The negative association of treatment break off with MAT assessment was more pronounced in semi-rural than urban areas (p<0.0001). CONCLUSION: Predictors relating to the well-being and functioning of the patient as well as the reasons underlying treatment termination appear to be more important for the treating physician's evaluation of medication-assisted treatment episodes than on-going substance use. Coming off the opioid medication plays a central role, independent of ongoing illicit substance use. Predictors relating to the well-being and functioning of the patient as well as the reasons underlying treatment termination appear to be more important for the treating physician's evaluation of medication-assisted treatment episodes than on-going substance use. Coming off the opioid medication plays a central role, independent of ongoing illicit substance use.

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Beliefs About Methadone in an Inner-City Methadone Clinic

Cited by 87 publications

References 13 publications

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

Patient Perspectives on Choosing Buprenorphine Over Methadone in an Urban, Equal-Access System

Evaluation of medication-assisted treatment of opioid dependence—The physicians’ perspective

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