Pathways to care and reasons for treatment-seeking behavior in patients with opioid dependence syndrome: An exploratory study

Abstract

Background: Magnitude of the menace of opioid dependence syndrome (ODS) is ever escalating especially in Northern India. However, no studies have been attempted to study the pathways to care and reasons for treatment-seeking behavior in patients with ODS. Aim: This study aims to investigate the pathways to care and reasons for treatment seeking in patients with ODS attending the community outreach clinic and de-addiction outpatient department (OPD) of a tertiary care teaching hospital. Materials and Methods: In a cross-sectional, exploratory study, a total of 40 patients diagnosed with ODS as per International Classification of Diseases-10 criteria who visited the psychiatry OPD and community outreach clinic were included. In addition to the sociodemographic and clinical variables, semi-structured questionnaires were developed by the Department of Psychiatry, Government Medical College and Hospital (GMCH), Chandigarh, India, for this study. These were first used in a pilot study and then used for the assessment of reasons for seeking treatment and pathways to care from a particular setting that is either community outreach clinic or OPD. Results: Index study found out that 25% ODS patients attended OPD directly for the first time ever in their life for treatment and 55% attended community outreach clinic run by the Department of Psychiatry, GMCH, Chandigarh, India. For 30% and 35% of the individuals attending OPD and Community outreach clinic, respectively, the first point of contact ever in life since the first use of opioid was any other tertiary care center. Alternative medicine practitioners were consulted by about 20% of the patients seeking help for the first time from OPD and none amongst those attending community outreach clinic. Referral rate was also very low in OPD attending sample (20%) while absolute zero in the community sample. Whereas among reasons for seeking treatment, increasing drug cost was the most cited reason by OPD attending patients and ill-health effects by community clinic attending patients (35% each) in personal reasons, while family-related reasons were poor interpersonal relationships with family members in OPD treatment-seeking patients (45%) and family property dispute in community clinic attending patients (35%). Conclusion: It can be concluded from the study that <50% of patients with substance use disorders visit the psychiatrist for treatment on the first contact. It means that a large number of patients go to different places/people/services for advice/treatment. However, the cost of the drug was one of the main reasons for treatment-seeking behavior in this population. Community clinic attending patients are more aware about the treatment facility available in the vicinity of their dwelling place, thereby preferring a place nearby to their home for treatment.