Home > Client perspectives on barriers to progressing through methadone maintenance treatment in Ireland.

Millar, Sean (2019) Client perspectives on barriers to progressing through methadone maintenance treatment in Ireland. Drugnet Ireland , Issue 70, Summer 2019 , 18 p..

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Opiate use disorder (OUD) is a problem worldwide.1 European statistics show that there are approximately 1.3 million high-risk opioid users in the EU, where opioids are found in 82% of fatal overdoses.2 The most recent Irish data from 2014 estimated that there were 18,988 opiate users in the Republic of Ireland, giving a rate of 6.18 per thousand population aged 15‒64 years (95% CI: 6.09‒6.98).3 

 

Methadone has ideal properties for the long-term treatment of OUD. A single dose of methadone overpowers the symptoms of opioid withdrawal for 24–36 hours without producing analgesia, sedation or euphoria.4 In Ireland, at year-end 2016, there were 80 Health Service Executive (HSE) methadone specialist centres in operation, treating 5,438 clients.5 However, of these clients, only 17 were appropriately stabilised and, as such, transferred to the lower-risk community setting. This represented only 2.2% of the potential transferrable client population.

  

A recent Irish study aimed to identify reasons as to why clients remain ‘trapped’ in the high-risk, specialist clinical setting.6 In this research, published in the journal BMC Health Services Research, qualitative semi-structured interviews were undertaken with 17 clients of one of Ireland’s HSE Drug and Alcohol Services. Each client had a severe OUD and had spent on average 7.5 years engaging with the methadone maintenance treatment programme.

  

Results

Participants’ life journey prior to an OUD included adverse childhood experiences (ACEs) and early exposure to illicit drug use. It was found that factors resulting in clients initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness, and concurrent benzodiazepine use disorder, with subjects stating that these often resulted in loneliness and lack of life purpose. Living environments, a mistaken understanding of their illness, and poor communication with allied health professionals further perpetuated their OUD. Participants stated that positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients’ own suggestions for improving their journeys included employing a multisectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a ‘time-limit’ to engage with the programme or for their treatment to be postponed. 

 

Conclusions

The authors noted that methadone maintenance treatment is ideally placed to work collaboratively with public health in order to access and support vulnerable, high-risk individuals subjected to ACEs. They concluded that a cross-departmental, intergovernmental approach to address substance misuse as a societal issue as a whole is needed. In addition, it was recommended that subsequent work needs to be done on tackling vulnerable children’s exposure to illicit drug use, concurrent benzodiazepine use in individuals with OUD, their housing conditions, and their lack of life purpose and loneliness. 

1    Teoh Bing Fei J, Yee A and Habil MH (2016) Psychiatric comorbidity among patients on methadone maintenance therapy and its influence on quality of life. Am J Addict, 25(1): 49–55.

2    European Monitoring Centre for Drugs and Drug Addiction (2016) European drug report 2016: trends and developments. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/25579/

3    Hay G, Jaddoa A, Oyston J, Webster J and Van Hout MC (2017) Estimating the prevalence of problematic opiate use in Ireland using indirect statistical methods. Dublin: National Advisory Committee on Drugs and Alcohol. https://www.drugsandalcohol.ie/27233/

4    Stotts AL, Dodrill CL and Kosten TR (2009) Opioid dependence treatment: options in pharmacotherapy. Expert Opin Pharmacother, 10(11): 1727–40.

5    Department of Health (2016) Central Treatment List: summary report for HSE Mid-West clinic. Jan 2016–Dec 2016 inclusive. Dublin: Health Service Executive.

6    Moran L, Keenan E and Elmusharaf K (2018) Barriers to progressing through a methadone maintenance treatment programme: perspectives of the clients in the Mid-West of Ireland's drug and alcohol services. BMC Health Serv Res, 18(1): 911. https://www.drugsandalcohol.ie/30195/

Item Type:Article
Issue Title:Issue 70, Summer 2019
Date:September 2019
Page Range:18 p.
Publisher:Health Research Board
Volume:Issue 70, Summer 2019
EndNote:View
Subjects:HJ Treatment method > Substance disorder treatment method > Substance replacement method (substitution) > Methadone maintenance
J Health care, prevention and rehabilitation > Patient care management
J Health care, prevention and rehabilitation > Treatment and maintenance > Treatment factors
J Health care, prevention and rehabilitation > Treatment and maintenance > Patient attitude toward treatment
VA Geographic area > Europe > Ireland

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