PDF (Drugnet Ireland, issue 10)
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In Ireland there is very little published information that documents clients’ satisfaction with methadone treatment services. This review presents the results of two studies. O’Connor 1 collected her data in 1999 while UISCE 2 collected their data in 2003.
O’ Connor examined patient satisfaction with the pharmaceutical aspect of methadone treatment services provided between July 1998 and March 1999 using both quantitative (cross sectional survey, n=217) and qualitative techniques (combination of group and individual interviews, n=15). She acknowledges some limitations to the generalisability of her study due to the sampling methods.
According to the author, respondents were pleased to have access to treatment services, secure free treatment, and experience an improved standard of care. The clients expressed dissatisfaction with several issues. According to the respondents, there was a lack of choice with respect to substitution drugs. The respondents also reported that attendance at methadone treatment services could be a humiliating experience. Examples included, having to comply with punitive contracts, and having to consume methadone in a public place in pharmacy retail outlets. According to the respondents, the services provided at drug treatment facilities were limited with respect to opening hours, and social and personal support. The respondents also reported a problem with exposure to fellow clients that continued to use street opiates and attended methadone treatment services.
In October 2003, the Union for Improved Services, Communication and Education (UISCE) published a study that examined clients’ experiences and expectations of methadone treatment programmes. The study participants were taking long-term methadone maintenance and lived in the Dublin area. The researchers used both quantitative (survey) and qualitative (focus group) approaches to collect the information.
The sampling method for the survey, the rationale for the sample size chosen, and the response rate were not documented, so the generalisability of the study cannot be determined. Notwithstanding these possible limitations, the high levels of dissatisfaction with Methadone DTF compared with Physeptone were in line with O’Connor’s study.
Focus groups were conducted as part feedback on the survey results, and part public consultation process. The number of focus groups and the numbers attending each of the groups were not presented in the published report. Several issues emerged from the focus groups discussions: once again, respondents expressed high levels of dissatisfaction with Methadone DTF compared with Physeptone; respondents’ impression of drug treatment service personnel was that they were impersonal and uncaring; participants reported over-use of sanctions by health professionals; respondents said that the individual pharmacy contracts provide rights for the retailers but not for the clients; participants questioned the use of urinalysis as the best method for detecting illicit drug use; participants questioned the actions of health professionals based on urinalysis; respondents reported lack of confidentiality among service providers; clients reported lack of participation in their treatment plan, and the absence of an independent complaints procedure.
Surprisingly, there were no positive experiences with the current methadone treatment programme reported in the document, which indicates a possible bias in the information presented or in the manner by which it was collected. Despite potential bias, the findings of this study indicate that clients on long-term methadone maintenance want:
- to participate in their treatment plan and its subsequent monitoring and evaluation;
- a service that caters for the other morbidities associated with problem opiate use, such as blood-borne viruses and psychiatric disorders;
- courtesy from service providers;
- ·an independent body to decide the course of action in the event of a disagreement.
It is also apparent that clients taking methadone maintenance require impartial information on policy decisions that affect their treatment. The time delay could explain the increasing levels of dissatisfaction expressed by the respondents.
Notwithstanding the limitations of this first study by drug users, clients reported high levels of dissatisfaction with aspects of the methadone treatment services. While the staff that run the service may be disappointed with the drug users’ perception, these findings could be turned to opportunity and provide the first step in a partnership between clients and service providers to start to address these issues. The process could be conducted through the ‘service user charter’ in each health board area that was recommended in the current National Drugs Strategy 2001-2008’. When addressing these issues it is important to develop an approach that ensures that rules are adhered to but which is not, at the same time, overbearing.
1. O’Connor S (2002) Pharmaceutical Services for Patients in Methadone Treatment in Ireland and the Introduction of the Methadone Protocol Scheme. University of Dublin, Thesis for the degree of PhD. Available to read at the Library in Trinity College Dublin.
2. UISCE (2003) Methadone: What’s the Story? Dublin: Union for Improved Services, Communication and Education (Internal Publication).
|Issue Title:||Issue 10, March 2004|
|Page Range:||p. 6|
|Publisher:||Health Research Board|
|Accession Number:||HRB (Available)|
|Subjects:||VA Geographic area > Europe > Ireland|
J Health care, prevention and rehabilitation > Treatment and maintenance > patient attitude toward treatment
HJ Treatment method > Drugs and alcohol disorder treatment method > Drugs and alcohol replacement method (substitution) > Methadone maintenance
T Demographic characteristics > Drug user
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