Diversion of diacetylmorphine in heroin-assisted treatment - a focus group study among patients and treatment providers.

IF 2.8 3区 医学 Q2 PSYCHIATRY
Elisabeth Strickler, Zacharias Wicki, Jean N Westenberg, Johannes Strasser, Undine E Lang, Kenneth M Dürsteler, Maximilian Meyer, Marc Vogel
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引用次数: 0

Abstract

Introduction: Heroin-assisted treatment (HAT) involves the supervised administration of pharmaceutical heroin (diacetylmorphine, DAM), either injectable or oral, for individuals with severe opioid use disorder who have not achieved stabilization with conventional opioid agonist treatment. Despite its growing adoption, there is limited literature on the phenomenon of diversion in HAT. Diversion refers to the redirecting of legal prescription medications from their intended medical use to illegal or unauthorised use. This study aims to investigate the reasons for, experiences with, and consequences of DAM diversion, as reported by both patients and treatment providers.

Methods: In this qualitative study, two separate focus groups were conducted with patients and treatment providers (nurses, psychiatrists, social workers, and psychologists) respectively. Discussions were audio-recorded, transcribed, and analysed. Mayring's qualitative content analysis was used to evaluate findings.

Results: Five themes with fourteen categories emerged. Providers and patients both described procedures and motives of diversion, discussed the positive and negative consequences, and suggested solutions for reduced future diversion of DAM. An important motif for diversion stemmed from patients' urge for more autonomy over route, timing, and fractioning of administration, while also being used to finance concurrent cocaine use. Treatment providers and patients both noted that diversion may lead to increased overdose risk for individuals in and out of treatment. Nurses noted a substantial negative impact of diversion on the therapeutic relationship. Suggestions for reducing diversion included allowing for more take-home dosing, allowing for more flexibility in routes of administration, adapting HAT clinic opening hours, and providing effective treatment for cocaine use disorder.

Conclusions: The main drivers of diversion in HAT included a desire for more autonomy, unaddressed concurrent substance use, and significant barriers to the existing treatment options. Addressing patients' preferred opioid effect profile, accommodating their social needs, and managing concurrent cocaine use disorder may reduce diversion in the future.

二乙酰吗啡在海洛因辅助治疗中的转移——一项针对患者和治疗提供者的焦点小组研究。
简介:海洛因辅助治疗(HAT)涉及药物海洛因(二乙酰吗啡,DAM)的监督管理,无论是注射还是口服,用于严重阿片类药物使用障碍的个体,他们没有通过传统的阿片类药物激动剂治疗达到稳定。尽管越来越多的人采用这种方法,但关于HAT中转移现象的文献有限。转移是指将合法处方药从其预期医疗用途转移到非法或未经授权的用途。本研究旨在调查患者和治疗提供者报告的DAM转移的原因,经验和后果。方法:采用定性研究方法,分别对患者和治疗提供者(护士、精神科医生、社工和心理学家)进行两个单独的焦点小组研究。讨论被录音、记录和分析。使用Mayring的定性内容分析来评估研究结果。结果:出现了5个主题,共14个类别。提供者和患者都描述了转移的程序和动机,讨论了积极和消极的后果,并提出了减少未来DAM转移的解决方案。转移用药的一个重要动机源于患者对用药路线、时间和分配有更多自主权的要求,同时也用于资助同时使用可卡因。治疗提供者和患者都注意到,转移治疗可能会增加正在接受治疗和正在接受治疗的个体服用过量药物的风险。护士注意到转移对治疗关系的实质性负面影响。减少转移的建议包括允许更多的带回家给药,允许更灵活的给药路线,调整HAT诊所的开放时间,以及为可卡因使用障碍提供有效治疗。结论:HAT转移的主要驱动因素包括对更多自主权的渴望,未解决的同时药物使用,以及现有治疗方案的重大障碍。解决患者偏好的阿片类药物效应特征,适应他们的社会需求,并管理并发的可卡因使用障碍可能会减少未来的转移。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Addiction Research
European Addiction Research SUBSTANCE ABUSE-PSYCHIATRY
CiteScore
6.80
自引率
5.10%
发文量
32
审稿时长
>12 weeks
期刊介绍: ''European Addiction Research'' is a unique international scientific journal for the rapid publication of innovative research covering all aspects of addiction and related disorders. Representing an interdisciplinary forum for the exchange of recent data and expert opinion, it reflects the importance of a comprehensive approach to resolve the problems of substance abuse and addiction in Europe. Coverage ranges from clinical and research advances in the fields of psychiatry, biology, pharmacology and epidemiology to social, and legal implications of policy decisions. The goal is to facilitate open discussion among those interested in the scientific and clinical aspects of prevention, diagnosis and therapy as well as dealing with legal issues. An excellent range of original papers makes ‘European Addiction Research’ the forum of choice for all.
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