Factors predicting 6-month retention among people with opioid use disorders accessing outpatient methadone maintenance therapy in Tshwane, South Africa

Gloeck, Natasha; Harris, Bernice Nerine; Webb, Elizabeth M.; Scheibe, Andrew

doi:10.7196/samj.2020.v111i1.14884

Cited by 6 publications

(13 citation statements)

References 20 publications

(26 reference statements)

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“…Self-funding OST in Tshwane has also been shown to be negatively associated with retention in care. 35 It is likely that many people who use drugs in Mamelodi were aware of COSUP, as people are well networked and the service had been operational for the four years before COVID-19. It is possible that people were either not ready or did not want to initiate OST before lockdown and only sought help once faced with the interruption to income generation related to lockdown and a disruption in their access to heroin.…”

Section: Discussionmentioning

confidence: 99%

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

Bhoora

Gloeck

Scheibe

2022

Afr. j. prim. health care fam. med.

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Background: The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane’s Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response.Aim: To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal.Setting: Three community-based COSUP sites in Mamelodi (Tshwane, South Africa).Methods: A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data.Results: Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants’ median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol.Conclusion: Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists.Contribution: This research contributes to the limited data around short-acting tramadol for opioid withdrawal management in the African context, with specific focus on the need for increased access to opioid agonists for those who need them, in primary care settings.

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Section: Discussionmentioning

confidence: 99%

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

Bhoora

Gloeck

Scheibe

2022

Afr. j. prim. health care fam. med.

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“…Much like other South African research produced on harm reduction and OST, the participants were predominantly African men, under 35 years of age, single and unemployed. 11 , 19 , 21 These similarities are not to say that those who do not fit this particular demographic are not at risk. Interestingly, however, according to a recent quantitative study regarding OST retention in Tshwane, the white population group and those living in the inner city (as opposed to peri-urban settings) had better odds of retention.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, however, according to a recent quantitative study regarding OST retention in Tshwane, the white population group and those living in the inner city (as opposed to peri-urban settings) had better odds of retention. 21 …”

Section: Discussionmentioning

confidence: 99%

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Retention of service users on opioid substitution therapy in the City of Tshwane, South Africa

Goeieman

Nonyane

Nzaumvila

et al. 2023

African Journal of Primary Health Care & Family Medicine

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Background: Opioid substitution therapy (OST) is evidence-based treatment for opioid use disorders and, when taken as maintenance therapy, has proven health and social benefits. The benefits of OST are achieved through the retention of service users in the treatment programme.Aim: To identify factors that affected retention of service users who had OST interrupted in less than 6 months of being in an OST programme.Setting: This qualitative study was conducted with 19 service users from eight Community-Oriented Substance Use Programme (COSUP) sites in the City of Tshwane, Gauteng, South Africa.Methods: Participants were COSUP service users who had interrupted OST in less than 6 months since initiation and were purposefully selected from all COSUP sites. Demographic information was obtained and four focus group discussions covered challenges of OST retention. Discussions were recorded, transcribed and qualitatively analysed using Attride-Stirling’s thematic networks framework.Results: The 19 participants were all male, mostly black African, with a mean age of 26 years. Facilitators of retention in OST were individual readiness to change OST accessibility, positive family and peer support, treatment monitoring, understanding and managing expectations of service users, contribution in society and meaningful opportunities for engagement. Barriers were the cost of OST, bureaucracy within the programme, inability to communicate challenges timeously and effectively to treatment providers, boredom, cravings and poverty.Conclusion: Opioid substitution therapy programmes can ensure a holistic approach to prevent and treat harms related to illicit opioid use if they remain person-centred and are well-funded.Contribution: Understanding the barriers to, and facilitators of retention on OST can contribute to improved community-based service delivery.

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“…The treatment of OUD with OAMT as part of a larger care package is supported by strong evidence globally and in South Africa (Gloeck, Harris, Webb, & Scheibe, 2020;Scheibe, Shelly, Gerardy, et al, 2020;Lize Weich, 2010;WHO, 2004). Long term use of OAMT (≥ 6 months) is associated with reduced dependence, reduced morbidity, and mortality from infectious diseases, reduced criminal behaviour, improved physical and psychological health and better social integration and functioning (Gloeck et al, 2020). Scaling up of harm reduction programmes that include OAMT is feasible in South Africa (Scheibe et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: a cohort study

Tlali¹,

Scheibe

Ruffieux³

et al. 2022

Preprint

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BackgroundThe use of opioids is increasing globally, but data on opioid use disorder (OUD) in South Africa are scarce. This study examines the incidence of diagnosed OUD, opioid agonist use, and excess mortality among persons with OUD in South Africa’s private healthcare sector.MethodsWe conducted a cohort study of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having OUD if they received opioid agonists (buprenorphine or methadone), an ICD-10 F11 diagnosis for a mental and behavioural disorder due to opioid use, or an ICD-10 T40 diagnosis for opioid poisoning. We calculated adjusted hazard ratios (aHR) for factors associated with OUD, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 F11 diagnosis, and examined excess mortality among beneficiaries with OUD.ResultsOf 1,251,458 beneficiaries, 1,313 (0.1%) had OUD. Between 2011 and 2020, the incidence of OUD increased by 12% (95% CI 9%-14%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of OUD. The cumulative incidence of opioid agonist use was 10.6% (95% CI 8.3-13.2) at 3 years after receiving an F11 diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, OUD was associated with an increased risk of mortality (aHR 2.29, 95% CI 1.85-2.82). OUD was associated with a 7.63-year shorter life expectancy (95% CI 4.08-10.70).ConclusionsThe incidence of patients diagnosed with or treated for OUD in the private sector is increasing rapidly. People with OUD in the private sector are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of OUD is urgently needed to improve the health outcomes of people with OUD.

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Factors predicting 6-month retention among people with opioid use disorders accessing outpatient methadone maintenance therapy in Tshwane, South Africa

Cited by 6 publications

References 20 publications

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

Retention of service users on opioid substitution therapy in the City of Tshwane, South Africa

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: a cohort study

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