Treatment expectations and satisfaction of treatment‐refractory opioid‐dependent patients in RIOTT, the Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics

Abstract

Patients previously considered non-responsive to treatment appear to have similar treatment expectations and aspirations as other drug users in treatment. Supervised injectable opioid treatment patients consistently reported treatment satisfaction but also that more could be done to optimise aspects of current arrangement. This raised the challenging issue of the extent to which opinions of patients need to be taken into consideration in shaping future treatment provision. Future research may need to examine the extent of expectations 'fit' and the relationship between treatment sought and received.

A chance to stop and breathe: participants’ experiences in the North American Opiate Medication Initiative clinical trial

“…As expected, participants receiving injectable opioids at the clinic reported not using street opioids. As in prior studies [ 19 - 21 ], our data show that the secure drug supply translated into a significant decrease of engagement in illicit activities and the daily street hustle. This release of time, and in some cases resources, introduces an important challenge for patients and the community: how to fill this free time.…”

“…Few studies have explored patient perceptions of injectable DAM treatment using structured interviews, satisfaction measures [ 18 , 19 ], and qualitative data [ 18 - 22 ]. A qualitative study with 21 participants and family taking part in the Andalusian clinical trial explored the perceived impact of medically prescribed DAM administered under supervision.…”

Evidence on the Effectiveness of Heroin-Assisted Treatment

“…Studies comparing the acute effects of injectable heroin versus placebo (i.e., saline solution) among patients in the HAT RCTs have shown a significant and immediate effect of heroin injection on reducing stress response, anxiety, emotional excitation, and subjective craving; increasing emotional well-being; and suppressing cortisol levels (Blum et al, 2013;Gerber et al, 2012;Walter et al, 2011). As supported by qualitative research with HAT participants (Blanken et al, 2010b;Groshkova et al, 2013;Oviedo-Joekes et al, 2014b;Romo et al, 2009), the reliable and structured provision of pharmaceutical-grade heroin through the treatment program may have also reduced stress associated with obtaining an uncertain product through the illicit market and may have changed the psychological relationship with heroin use. Reduced involvement with the illicit drug scene among HAT patients may also play a role in reducing exposure to environmental heroin-related cues.…”

Men’s and women’s response to treatment and perceptions of outcomes in a randomized controlled trial of injectable opioid assisted treatment for severe opioid use disorder

“…Prior studies on patients receiving injectable opioids under supervision suggest that engaging patients in research regarding their perceptions of treatment (e.g. treatment expectations, treatment effectiveness) can provide a comprehensive assessment of treatment challenges and treatment needs in order to optimize the treatment received as they progress through treatment [50, 51]. …”