Changes in self-reported mental health, anxiety and depression among patients in heroin-assisted treatment: Findings from a Norwegian trial project.

Abstract

Introduction Norway's HAT project started in 2022, aimed at targeting individuals with severe opioid use disorder (OUD) who did not benefit from first-line, conventional opioid agonist treatment (OAT). The use of pharmaceutical diacetylmorphine in heroin-assisted treatment (HAT) may particularly benefit patients with comorbid psychiatric disorders due to its structured nature, which includes daily contact with outpatient clinics. However, previous findings on mental health outcomes in HAT have been inconclusive. The main aim of this study was to explore changes in patients' self-rated mental health and anxiety and depression over the first 12 months of HAT in Norway. Methods We used data from two questions about patients' self-rated mental health and anxiety and depression collected from 79 patients at the start of treatment (baseline) and at 3, 6, and 12 months into treatment. Ordinal logistic regression models were used to examine the changes in the responses over the observational period, and to explore the potential effects of predictors such as gender and age, self-reported substance use, and clinic site. Results We found a gradual improvement in self-rated mental health from baseline over the observational period, with a statistically significant shift in response distribution at the 12-month mark (p=0.017). The distribution of responses indicating 'good' mental health increased with a 35% improvement at 12 months, with a corresponding decline of 48% in 'bad' mental health. For self-rated anxiety and depression, we found no change in severity of self-rated symptoms. A decline of 48% in the proportion of responses reporting severe symptoms at 12 months was aligned with a simultaneous increase of 17% reporting moderate symptoms. Age and previous suicide attempts were significant predictors of both outcomes; gender influenced anxiety and depression only, whereas clinic site influenced only mental health ratings. Conclusion Heroin-assisted treatment appears to gradually improve patients' self-rated mental health over time, possibly by enhancing overall psychological well-being. Self-rated symptoms of anxiety and depression may not be affected by this treatment, indicating that psychiatric conditions can persist in HAT for those struggling with them. This highlights the importance of specific psychiatric assessments and targeted interventions for at least a subset of patients, underscoring the need for integrated treatment approaches within HAT programs that address both substance use and co-occurring psychiatric disorders.