The “black box” of treatment: Patients’ perspective on what works in opioid maintenance treatment for opioid dependence

Abstract

Background A lack of conceptual modeling of how the components of opioid maintenance treatment (OMT) for opioid dependence (OD) work causes it to occasionally be labeled the “black-box” of treatment. This study had a two-fold objective: First, to analyze which factors related to OMT for OD contribute to the abstinence of problematic use of non-prescribed opioids and sustain recovery, from the patients’ perspective; second, to understand which changes OMT produced in the individuals’ lives might significantly contribute to relapse prevention. Methods We used qualitative methods of design, inquiry, and analysis from a convenience sample of 19 individuals in a Swedish treatment setting. Results All the participants reported previous cycles of problematic use of non-prescribed opioids and other non-prescribed psychoactive substances, treatment, abstinence, recovery, and relapse before starting the current OMT program. During the pre-treatment stage, specific events, internal processes, and social environments enhanced motivation toward abstinence and seeking treatment. During the treatment stage, participants perceived the quality of the human relationships established with primary social groups as important as medication and the individual plan of care in sustaining recovery. From the participants’ perspective, OMT was a turning point in their life course, allowing them a sense of self-fulfillment and the reconstruction of personal and social identity. However, they still struggled with the stigmatization produced by a society that values abstinence-oriented over medication-assisted treatments. Conclusion OMT is not an isolated event in individuals’ lives but rather a process occurring within a specific social context. Structural factors and the sense of acceptance and belonging are essential in supporting the transformation. Treatment achievements and the risk for relapse vary over time, so the objectives of the treatment plan must account for characteristics of the pre-treatment stage and the availability and capacity of individuals to restructure their social network, besides the opioid maintenance treatment and institutional social care.

Economic, social, and clinic influences on opioid treatment program retention in Dar es Salaam, Tanzania: a qualitative study

“…Family support was identified as a key facilitator of MOUD retention. Consistent with research in other settings [32,33], the reestablishment of familial relationships following enrollment on MOUD was essential to garnering emotional and instrumental support, which helped to overcome economic barriers to retention, particularly transportation cost which is well documented as a barrier to accessing and remaining on MOUD [12,34,35]. However, lack of understanding of methadone and continued mistrust threatened clients' ability to rebuild trust and maintain family support.…”

Patients’ Perspectives on Coming Off Opioid Agonist Treatment: A Qualitative Study

“…To reduce the stigma and optimize treatment, it is crucial to take patients´ experiences into consideration. 44,48,50 Participants in our study highlighted the importance of being treated with respect for individuality. They described that it was necessary to feel in control of their treatment if they were to be able to take steps forward.…”

“… 45 However, there are indications that clinics serving patients in OAT are less likely to use person-centered care than health care in general. 46 - 48 Recent studies have reported a lack of patient input into treatment decisions in OAT, which makes the patients feel under the control of the health care authority, rather than in own control. 49 This, in turn, may create conditions for poor outcomes with OAT.…”

Patient’s and healthcare provider’s experiences with Opioid Maintenance Treatment (OMT): A qualitative evidence synthesis

“…al., 2019; De Maeyer et al, 2011; Harris, 2015;Korthuis et al, 2010). At the same time, not being able to socialize with old friends could entail social isolation and loneliness(Silva & Andersson, 2021). These kinds of social structureswhich many expected to improve through OMT-affected the patient's ability to carry out treatment.…”

“…Their beliefs were rooted in the societal perceptions of persons with opioid addiction and OMT(Bates & Martin-Misener, 2022). On the other hand, healthcare providers also had an in uence on society's health perceptions and acceptance and perceived warmth displayed by healthcare providers were considered of great importance for treatment success(Marchand et al, 2020;Silva & Andersson, 2021).…”