Consumer and treatment provider perspectives on reducing barriers to opioid substitution treatment and improving treatment attractiveness

Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectives

“…Often, staff turnover and burocratic regulations (e.g. weekly appointments) hamper a flexible, individualised approach and continuity of care (Deering et al, 2011). Consequently, the establishment of safe and caring working environments is necessary to keep up workers' wellbeing and job satisfaction, as well as the creation of organisational structures that increase the availability of individual key workers or case managers who can address clients' needs appropriately over time (Dixon-Woods et al, 2005;Lilly, Quirk, Rhodes, & Stimson, 2000;Vanderplasschen, Wolf, Rapp, & Broekaert, 2007).…”

“…MMT clients have voiced concerns regarding daily collections and limited methadone collection times, lengthy wait times, lack of privacy in pharmacies and the specific pharmacological qualities of methadone (Deering et al, 2011;Harris & McElrath, 2012). Promoting retention has become a therapeutic aim in itself as it reduces relapse and mortality, but disregards the aspirations and goals of long-term MMT clients who often find themselves ''stuck'' in treatment (Madden, Toby, Bath, & Winstock, 2008;Winstock et al, 2011).…”

Dosis de metadona y su relación con calidad de vida, satisfacción, psicopatología, rendimiento cognitivo y consumo adicional de sustancias no prescritas

“…Si bien la motivación es una variable decisiva para la obtención de buenos resultados en el tratamiento, con independencia de las dosis administradas (Zeldman, Ryan y Fiscella, 2004), muchos estudios coinciden en constatar que los pacientes encuentran diversas barreras para entrar y permanecer en los programas de metadona: el trato recibido por el equipo terapéutico y la consideración de "enfermos", los largos tiempos de espera, la inflexibilidad en la prescripción de dosis, la ocultación de las dosis recibidas, la probable estancia indefinida, la consideración de recibir dosis demasiado altas o la falta de participación requerida en su dosificación, entre otros (p. ej., Al-Tayyib y Koester, 2011; Deering et al, 2011;Peterson et al, 2010). En sentido contrario, la satisfacción con el tratamiento recibido, la asistencia a actividades psicoterapéuticas y la sensación de que el tratamiento resulta beneficioso, son cuestiones que mejoran la retención con independencia de las dosis recibidas (Kelly, O'Grady, Brown, Mitchell y Schwartz, 2010;Montgomery, Sanning, Litvak y Peters, 2014;Vanderplasschen, Naert, Vander Laenen y De Maeyer, 2014), de modo que la satisfacción presenta una capacidad predictiva sobre la retención de la que carece la dosis administrada (Kelly, O'Grady, Brown, Mitchell y Schwartz, 2011).…”

Opioid pharmacotherapy: Treatment, regimes, constructions and control

“…Detrimental impacts are also reported in regard to dental health, personal motivation and self esteem Fischer et al, 2002;Holt, 2007;Stancliff, Myers, Steiner, & Drucker, 2002). Restrictive treatment regimes have the capacity to foster suspicion and mistrust, further alienating already stigmatised clients from services and creating a barrier to commencement and retention (Deering et al, 2011;Fischer et al, 2002). Additional barriers to treatment uptake and retention include concerns about stigma and lifestyle restrictions, self medication preferences, and reluctance to be officially identified as an 'addict' (Deering et al, 2011;Fischer et al, 2002;Peterson et al, 2010), an identification experienced as particularly risky for women with children (Fountain, Strang, Gossop, Farrel, & Griffiths, 2000).…”

“…Restrictive treatment regimes have the capacity to foster suspicion and mistrust, further alienating already stigmatised clients from services and creating a barrier to commencement and retention (Deering et al, 2011;Fischer et al, 2002). Additional barriers to treatment uptake and retention include concerns about stigma and lifestyle restrictions, self medication preferences, and reluctance to be officially identified as an 'addict' (Deering et al, 2011;Fischer et al, 2002;Peterson et al, 2010), an identification experienced as particularly risky for women with children (Fountain, Strang, Gossop, Farrel, & Griffiths, 2000). When asked about potential treatment improvements, research participants commonly refer to prescribing practices and dosing regimes.…”