A Qualitative Study of Prescribing Doctor Experiences of Methadone Maintenance Treatment
- 379 Downloads
Methadone maintenance treatment [MMT] is recognized as an effective treatment for opiate dependence. It is provided in Ireland in addiction clinics and for stabilized patients in primary care. The aim of the study was to explore doctor’s experiences of methadone prescribing, therapeutic alliance and methadone treatment pathways. Semi structured interviews were conducted with a convenience sample of prescribing doctors (n = 16). Thematic analysis of narratives was undertaken. Observations around MMT were positive in reducing harm associated with injecting drug use and opiate dependence, and represented an important turning point for patients. Doctor efforts to assist their patients were grounded in positive, empathic relationships. Some concerns were relayed with regard to prescribing restrictions. Participants commented on the need for policy makers to consider the expansion of MMT provision to include alternative pharmacological approaches, improved interagency, psychosocial and detoxification supports, community based nurse prescribing and adjunct treatment for poly drug and alcohol use.
KeywordsMethadone Shared care Opiate dependence
The authors would like to thank the doctors who participated in the study.
The research was funded by the Dublin North East Task Force, Ireland. The opinions expressed in this article are of the researchers and are not necessarily those of the Dublin North East Task Force.
Conflict of Interest
The authors report no conflict of interest.
- Amato, L., Davoli, M., Perucci, C. A., Ferri, M., Faggiano, F., & Mattick, R. P. (2005). An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment, 28, 321–329.PubMedCrossRefGoogle Scholar
- Appel, R. W., Ellison, A. A., Hadley, K. J., & Oldak, R. (2004). Barriers to enrollment in drug abuse treatment and suggestions for reducing them: stakeholders. The American Journal of Drug and Alcohol Abuse, 30(129), 153.Google Scholar
- Bell, J., Burrell, T., Indig, D., & Gilmour, S. (2006). Cycling in and out of treatment: Participation in methadone treatment in NSW, 1990–2002. Drug and Alcohol Dependence, 81, 55–61.Google Scholar
- Bobrova, N., Alcorn, R., Rhodes, T., Rughnikov, I., Neifeld, E., & Power, R. (2007). Injection drug users’ perceptions of drug treatment services and attitudes toward substitution therapy: a qualitative study in three Russian cities. Journal of Substance Abuse Treatment, 33, 373–378.PubMedCrossRefGoogle Scholar
- Butler, S. (2002). The making of the methadone protocol: the Irish system? Drugs: Education, Prevention and Policy, 9, 311–324.Google Scholar
- Delargy, I. (2008). Survey of general practitioners participating in the methadone treatment programme. Dublin: Irish College of General Practitioners.Google Scholar
- Dennis M., Scott CK., Funk R., & Foss M., (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment, 28, 51–62Google Scholar
- Dole, V. P., & Nyswander, M. E. (1980). Methadone maintenance: A theoretical perspective. In D. J. Lettieri, M., Sayers, & H. W. Pearson (Eds.), Theories on drug abuse: Selected contemporary perspectives (pp. 256–261). NIDA Research Monograph 30. Washington, DC: U. S. Government Printing Office. Available from: http://archives.drugabuse.gov/pdf/monographs/download30.html (Accessed 12 December 2011).
- Farrell, M., & Barry, J. (2010). The introduction of the Opioid Treatment Protocol. Dublin: Health Service Executive. Available from: www.drugsandalcohol.ie/14458 (Accessed 14 December 2011).
- Friedman, S. R., Tempalski, B., Perlis, T., Keem, M., Friedman, R., & Flom, P. (2004). Estimating numbers of injecting drugs users in metropolitan areas for structural analyses of community vulnerability and for assessing relative degrees of service provision for injection drug users. Journal of Urban Health, 81, 377–400.PubMedCentralPubMedCrossRefGoogle Scholar
- Gabbay, M., Shiels, C., & vanden Bos, A. (2001). Turning the tide’: influencing future GP attitudes to opiate misusers. Education for General Practice, 12, 144–152.Google Scholar
- Gjersing, L., Waal, H., Caplehorn, J.R.M., Gossop, M., & Clausen, T., et al. (2010). Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment, BMC Health Services Research, 10, 194.Google Scholar
- Gowing, L. R., Ali, R. L., & White, J. M. (2000b). Buprenorphine for the management of opioid withdrawal. The Cochrane Library, 8, 3.Google Scholar
- Grella, C. E., Karno M. P., Warda U. S., Moore A. A., Niv N. (2009). Perceptions of need and help received for substance dependence in a national probability survey. Psychiatric Services, 60, 1068–1074.Google Scholar
- Harris, J., & McElrath, K. (2012). Methadone as Social Control: Institutionalized Stigma and the Prospect of Recovery. Qualitative Health Research. January, 9th 2012, Early Online.Google Scholar
- Health Service Executive (2011). The introduction of the opioid treatment protocol. Dublin. Available from: www.drugs.ie/pdfs/2010/Opioid_Treatment_Protocol.pdf (Accessed 12 December 2011).
- Hopkins, A., & Clark, D. (2005). Using heroin, trying to stop, and accessing treatment: A qualitative analysis of the experiences and vies of clients on the Peterborough Nene Drug Interventions Programme, unpublished.Google Scholar
- Joseph, H., Stancliff, S., & Langrod, J. (2000). Methadone maintenance treatment (MMT): a review of historical and clinical issues. The Mount Sinai Journal of Medicine, 67, 347–364.Google Scholar
- Kapadia, N., Fox, D., Rowlands, G., & Ashworth, M. (2007). Developing primary care services for high-dose benzodiazepine-dependent patients: a consultation survey. Drugs: Education, Prevention and Policy, 14, 429–442.Google Scholar
- Lloyd, C. (2010). Sinning and sinned against: The stigmatisation of problem drug users. York: University of York.Google Scholar
- Mattick, R. P., Ali, R., & Lintzeris, N. (Eds.). (2009). Pharmacotherapies for the treatment of opioid dependence: Efficacy, cost-effectiveness, and implementation guidelines. New York: Informa Healthcare.Google Scholar
- McDonnell, A., & Van Hout, M. (2011). Heroin detoxification-seeking, a grounded theory of process and practicalities. The Grounded Theory Review, 10, 17–14.Google Scholar
- McKeganey, N., Morris, Z., Neale, J., & Robertson, M. (2004). What are drug users looking for when they contact drug services: abstinence or harm reduction. Drugs: Education, Prevention and Policy, 11, 423–435.Google Scholar
- Methadone Prescribing Implementation Committee (2005). Review of the Methadone Treatment Protocol. Dublin: Department of Health and Children. Available from: www.drugsandalcohol.ie/5962 (Accessed 12 December 2011).
- Ormston, R., Bradshaw, P., & Anderson, S. (2010). Scottish social attitudes survey 2009: Public attitudes to drugs and drug use in Scotland. Edinburgh: Scottish Government Social Research.Google Scholar
- Richards, L. (2005). Handling qualitative data: A practical guide. London: Sage Publications.Google Scholar
- Schuckit, M. (2006). Drug and alcohol abuse. A clinical guide to diagnosis and treatment (6th ed.). New York: Springer.Google Scholar
- Taylor, S. J., & Bogdan, R. (1984). Introduction to qualitative research methods: The search for meanings. New York: Wiley.Google Scholar
- Van den Brink, W., & Haasen, C. (2006). Evidenced-based treatment of opioid-dependent patients. Canadian Journal of Psychiatry, 51, 635–646.Google Scholar
- Van Hout, M. C., & Bingham, T. (2012). Methadone maintenance and special community employment schemes: a study of Irish participants’ views. Journal of Vocational Rehabilitation, 37, 63–73.Google Scholar
- Van Hout, M. C., & McElrath, K. (2012). Service user involvement in drug treatment programs: Barriers to implementation and potential benefits for client recovery. Drugs Education, Prevention and Policy. Early Online, 1–10.Google Scholar
- World Health Organisation (2009). Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Geneva: World Health Organisation. Accessed on July 10th 2011 at www.who.com.