A chance to stop and breathe: participants' experiences in the North American Opiate Medication Initiative clinical trial

Eugenia Oviedo-Joekes, Kirsten Marchand, Kurt Lock, Jill Chettiar, David C Marsh, Suzanne Brissette, Aslam H Anis, Martin T Schechter, Eugenia Oviedo-Joekes, Kirsten Marchand, Kurt Lock, Jill Chettiar, David C Marsh, Suzanne Brissette, Aslam H Anis, Martin T Schechter

Abstract

Background: The North American Opiate Medication Initiative (NAOMI) clinical trial compared the effectiveness of injectable diacetylmorphine (DAM) or hydromorphone (HDM) to oral methadone maintenance treatment (MMT). This study aimed to determine participants' perceptions of treatment delivered in NAOMI.

Methods: A qualitative sub-study was conducted with 29 participants (12 female): 18 (62.1%) received injectable DAM or HDM and 11 (37.9%) received MMT. A phenomenological theoretical framework was used. Semi-structured interviews were audio-recorded and transcribed verbatim. A thematic analysis was used over successive phases and was driven by the semantic meanings of the data.

Results: Participants receiving injectable medications suggested that the supervised delivery model was stringent but provided valuable stability to their lives. Females discussed the adjustment required for the clinical setting, while males focused on the challenging clinic schedule and its impact on employment abilities. Participants receiving MMT described disappointment with being randomized to this treatment; however, positive aspects, including the quick titration time and availability of auxiliary services, were also discussed.

Conclusion: Treatment with injectable DAM (or HDM) is preferred by participants and considered effective in reducing the burden of opioid dependency. Engaging patients in research regarding their perceptions of treatment provides a comprehensive assessment of treatment needs and barriers.

Clinical trial registration: NCT00175357.

References

    1. McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284:1689–1695. doi: 10.1001/jama.284.13.1689.
    1. Van den Brink W, Haasen C. Evidenced-based treatment of opioid-dependent patients. Can J Psychiatry. 2006;51:635–646.
    1. March JC, Oviedo-Joekes E, Romero M. Drugs and social exclusion in ten European cities. Eur Addict Res. 2006;12:33–41. doi: 10.1159/000088581.
    1. De Jong CA, Roozen HG, van Rossum LG, Krabbe PF, Kerkhof AJ. High abstinence rates in heroin addicts by a new comprehensive treatment approach. Am J Addict. 2007;16:124–130. doi: 10.1080/10550490601184472.
    1. Farrell M, Ward J, Mattick R, Hall W, Stimson GV, des Jarlais D, Gossop M, Strang J. Methadone maintenance treatment in opiate dependence: a review. BMJ. 1994;309:997–1001. doi: 10.1136/bmj.309.6960.997.
    1. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;3:CD002209.
    1. Mino A, Page D, Dumont P, Broers B. Treatment failure and methadone dose in a public methadone maintenance treatment programme in Geneva. Drug Alcohol Depend. 1998;50:233–239. doi: 10.1016/S0376-8716(98)00035-0.
    1. van den Brink W, Hendriks VM, Blanken P, Koeter MW, van Zwieten BJ, van Ree JM. Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials. BMJ. 2003;327:310. doi: 10.1136/bmj.327.7410.310.
    1. Brands J, Brands B, Marsh D. The expansion of methadone prescribing in Ontario, 1996–1998. Addict Res Theory. 2000;8:485–496. doi: 10.3109/16066350009005592.
    1. Brands B, Blake J, Marsh D. Changing patient characteristics with increased methadone maintenance availability. Drug Alcohol Depend. 2002;66:11–20. doi: 10.1016/S0376-8716(01)00176-4.
    1. Ferri M, Davoli M, Perucci CA. Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database Syst Rev. 2011;12:CD003410.
    1. Oviedo-Joekes E, Brissette S, Marsh DC, Lauzon P, Guh D, Anis A, Schechter MT. Diacetylmorphine versus methadone for the treatment of opioid addiction. N Engl J Med. 2009;361:777–786. doi: 10.1056/NEJMoa0810635.
    1. DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–209. doi: 10.1097/01.mlr.0000114908.90348.f9.
    1. Bourgois P. Anthropology and epidemiology on drugs: the challenges of cross-methodological and theoretical dialogue. Int J Drug Policy. 2002;13:259–269. doi: 10.1016/S0955-3959(02)00115-9.
    1. Trujols J, Iraurgi I, Oviedo-Joekes E, Guardia-Olmos G. A critical analysis of user satisfaction surveys in addiction services: opioid maintenance treatment as a representative case study. Patient Prefer Adherence. 2014;8:107–117.
    1. Beaulieu MD. Toward a patient-centred health care system. Can Fam Physician. 2013;59:109–110.
    1. Hebert PC. Measuring performance is essential to patient-centred care. CMAJ. 2010;182:225. doi: 10.1503/cmaj.100053.
    1. Marchand KI, Oviedo-Joekes E, Guh D, Brissette S, Marsh DC, Schechter MT. Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency. BMC Health Serv Res. 2011;11:174. doi: 10.1186/1472-6963-11-174.
    1. Groshkova T, Metrebian N, Hallam C, Charles V, Martin A, Forzisi L, Lintzeris N, Strang J. Treatment expectations and satisfaction of treatment-refractory opioid-dependent patients in RIOTT, the randomised injectable opiate treatment trial, the UK’s first supervised injectable maintenance clinics. Drug Alcohol Rev. 2013;32:566–573. doi: 10.1111/dar.12062.
    1. Romo N, Poo M, Ballesta R. PEPSA Team. From illegal poison to legal medicine: a qualitative research in a heroin-prescription trial in Spain. Drug Alcohol Rev. 2009;28:186–195. doi: 10.1111/j.1465-3362.2008.00015.x.
    1. Blanken P, van den Brink W, Hendriks VM, Huijsman IA, Klous MG, Rook EJ, Wakelin JS, Barendrecht C, Beijnen JH, van Ree JM. Heroin-assisted treatment in the Netherlands: history, findings, and international context. Eur Neuropsychopharmacol. 2010;20(Suppl 2):S105–S158.
    1. Romero M, March JC, Oviedo-Joekes E, PEPSA Team. 17th International Conference on the Reduction of Drug Related Harm. Canada: Vancouver; 2006. “The problem is that, besides needing the drug, we have lost everything:” the Andalusian heroin trial from the participants’ side.
    1. Oviedo-Joekes E, Nosyk B, Brissette S, Chettiar J, Schneeberger P, Marsh DC, Krausz M, Anis A, Schechter MT. The North American opiate medication initiative (NAOMI): profile of participants in North America’s first trial of heroin-assisted treatment. J Urban Health. 2008;85:812–825. doi: 10.1007/s11524-008-9312-9.
    1. Oviedo-Joekes E, Nosyk B, Marsh DC, Guh D, Brissette S, Gartry C, Krausz M, Anis A, Schechter MT. Scientific and political challenges in North America’s first randomized controlled trial of heroin-assisted treatment for severe heroin addiction: rationale and design of the NAOMI Study. Clin Trials. 2009;6:261–271. doi: 10.1177/1740774509105222.
    1. World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–2194.
    1. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–357. doi: 10.1093/intqhc/mzm042.
    1. Daly J, Willis K, Small R, Green J, Welch N, Kealy M, Hughes E. A hierarchy of evidence for assessing qualitative health research. J Clin Epidemiol. 2007;60:43–49. doi: 10.1016/j.jclinepi.2006.03.014.
    1. Ayres L. Qualitative research proposals—part III: sampling and data collection. J Wound Ostomy Continence Nurs. 2007;34:242–244. doi: 10.1097/01.WON.0000270816.99318.3b.
    1. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Education for Information. 2004;22:63–75.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. doi: 10.1191/1478088706qp063oa.
    1. NVivo. Qualitative Solutions and Research, Pty. Ltd. Australia: NVivo qualitative data anaylsis software; QSR International Pty Ltd; 2008.
    1. Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000;320:114–116. doi: 10.1136/bmj.320.7227.114.
    1. Nosyk B, Geller J, Guh DP, Oviedo-Joekes E, Brissette S, Marsh DC, Schechter MT, Anis AH. The effect of motivational status on treatment outcome in the North American opiate medication initiative (NAOMI) study. Drug Alcohol Depend. 2010;111:161–165. doi: 10.1016/j.drugalcdep.2010.03.019.
    1. Oviedo-Joekes E, Guh D, Brissette S, Marchand K, Marsh D, Chettiar J, Nosyk B, Krausz M, Anis A, Schechter MT. Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women. Drug Alcohol Depend. 2010;111:50–57. doi: 10.1016/j.drugalcdep.2010.03.016.
    1. Clark N. Injectable diacetylmorphine is more effective than oral methadone in the treatment of chronic relapsing opioid dependence. Evid Based Ment Health. 2010;13:80. doi: 10.1136/ebmh1051.
    1. European Monitoring Centre for Drugs and Drug Addiction. New heroin-assisted treatment. Recent evidence and current practices of supervised injectable heroin treatment in Europe and beyond. Lisbon: European Monitoring Centre for Drugs and Drug Addiction; 2011.
    1. Publique OFdIS. Book Traitement avec prescription d’héroïne (HeGeBe) en 2009 et 2010. Swiss: Office Fédéral de la Santé Publique; 2011. Traitement avec prescription d’héroïne (HeGeBe) en 2009 et 2010.
    1. Verthein U, Bonorden-Kleij K, Degkwitz P, Dilg C, Kohler WK, Passie T, Soyka M, Tanger S, Vogel M, Haasen C. Long-term effects of heroin-assisted treatment in Germany. Addiction. 2008;103:960–966. doi: 10.1111/j.1360-0443.2008.02185.x. discussion 967–968.

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