Factors influencing recovery in opioid substitution treatment: a systematic review and thematic synthesis

Abstract

Background and Aims Recovery outcomes for opioid substitution treatment are poorer than those for alcohol and other drugs. In order to understand why this is and to synthesise the findings of a large number of qualitative studies, we conducted a systematic review and thematic synthesis to understand facilitators of and barriers to recovery from opioid dependency. Methods Electronic databases (Pubmed, PsychInfo, CINAHL and Embase) were searched. English language studies exploring the views of adult service user and stakeholders with experiences of opioid substitution treatment were considered for inclusion. Included studies were inductively analysed using thematic synthesis. During analysis, the socioecological model was selected as an analytical framework for organising and making links between themes as it captured the complexity of the topic well. ResultsFrom 3646 screened papers, we included 37 studies reporting the views of 1212 staff and service users. Studies highlighted complex interactions between factors influencing recovery across the five levels of the socioecological model (intrapersonal, inter-personal, organisational, community and policy). Early life experiences of trauma were common; lack of support (both psychological and social) was also a recurring theme resulting in feelings of disconnection and isolation. Stigma played a particularly important role in an individual’s capacity to recover from opioid dependency and cut-across all levels of the socioecological model. Conclusions Interventions targeted at the individual level fail to take account of the complexity of recovery within opioid substitution treatment and may ignore the complex socio-political context that service users and services exist within. Stigma permeates all levels of the opioid substitution treatment system; we suggest that addressing this is likely to improve healthcare encounters, help-seeking, increase access to social support and facilitate community reintegration for individuals receiving opioid substitution treatment.

Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys

“…By considering findings in relation to the socioecological model, we have shown that treatment journeys within OAT are constrained by complex interactions between the individual and wider contextual factors. Our study therefore builds upon the work of previous researchers who have explored treatment experiences in OAT from an ecological perspective (e.g., [ 39 , 45 , 46 ]) and specifically offers consideration of these factors within the UK treatment system. Adopting a systems perspective is key to developing interventions that take into account contextual factors and the relationships between these [ 90 , 91 ].…”

“…Socioecological approaches allow for the exploration of issues across five levels: individual, intrapersonal, organisational, community and policy [ 38 ]. Such models are increasingly used to study public health issues, including opioid use and dependency (e.g., [ 39 , 40 , 41 , 42 , 43 , 44 ]). However, only a small number of studies have adopted this approach to specifically explore experiences of OAT [ 39 , 45 , 46 ], and, to our knowledge, no studies have been conducted in a UK treatment context.…”

“…Such models are increasingly used to study public health issues, including opioid use and dependency (e.g., [ 39 , 40 , 41 , 42 , 43 , 44 ]). However, only a small number of studies have adopted this approach to specifically explore experiences of OAT [ 39 , 45 , 46 ], and, to our knowledge, no studies have been conducted in a UK treatment context. Recently, Dame Carol Black’s review of drugs [ 47 , 48 ] identified issues of chronic underfunding and called for increased funding for both drug treatment and wider recovery support, as well as the need to take a systemic approach to addressing drug use.…”

Barriers and facilitators to naloxone uptake in Ohio: implications for community-driven overdose reduction interventions

“…This approach is more likely to sustain prevention efforts over time and achieve population-level impact. Since its inception, the SEM has been utilized, modi ed, and applied within various public health promotion contexts, including contextualizing the opioid crisis [13][14][15][16][17][18][19][20][21]. Its use is a practical approach for assessing the multi-faceted barriers and facilitators of Naloxone use and informs the development of evidence-based community interventions.…”

Problematisk opioidanvändning: om opioidrelaterade dödsfall och LARO i södra Sverige

“…Detta beror dels på den maktobalans som förekommer generellt mellan brukare och (företrädare för) välfärdsorganisationer och som kan härledas till olika positioner och kunskapsnivåer (Börjesson & Rehn, 2009;Nordgren, 2003), dels på att den asymmetriska maktrelationen förstärks när det som i LARO handlar om en livsnödvändig medicin som personalen styr över och patienterna behöver Järvinen & Miller, 2010;. Stigmatiserande samhällsattityder kring LARO och droganvändning generellt kan dessutom ha betydelse även i det här sammanhanget (Carlisle et al, 2020;Hatzenbuehler et al, 2013;Matthews et al, 2017).…”