Factors influencing engagement and utilisation of opium tincture-assisted treatment for opioid use disorder: A qualitative study in Tehran, Iran.
barriers
opioid use disorder
opium tincture
qualitative study
treatment
Journal
Drug and alcohol review
ISSN: 1465-3362
Titre abrégé: Drug Alcohol Rev
Pays: Australia
ID NLM: 9015440
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
revised:
02
06
2021
received:
05
01
2021
accepted:
03
07
2021
pubmed:
27
7
2021
medline:
1
4
2022
entrez:
26
7
2021
Statut:
ppublish
Résumé
In response to a high burden of opioid use disorder (OUD), Iran established a network of opioid agonist treatment (OAT) centres beginning in 2002. To increase treatment diversity, particularly for patients who use opium as their drug of choice, opium tincture (OT)-assisted treatment was introduced to the network. This study aimed to explore factors influencing OT-assisted treatment selection for OUD in Tehran, Iran. We conducted 54 in-depth interviews with patients with OUD (n = 33), family members of patients (n = 9) and drug treatment providers (n = 12). Participants were recruited from 12 drug treatment centres across Tehran, between September and November 2019. All interviews were audio-recorded, transcribed and coded in OpenCode 4.02 software and analysed using thematic analysis. Study participants more commonly reported individual-level factors as facilitators (e.g. to reduce harms associated with illicit opioid use, achieve recovery through a gradual dose reduction regimen combined with Congress 60 recovery program) and structural level factors (e.g. low adoption by OAT system and lack of familiarity of treatment providers) as barriers for utilisation of OT-assisted treatment regimens. OT was perceived to produce lower levels of physiological dependence than methadone, but the requirement for twice supervised dosing was restrictive. Low familial and community acceptance were also seen as barriers to access. This research identified a range of perceived benefits for OT-assisted treatment ranging from harm reduction to an intermediate step to achieve recovery. However, several structural-, individual-, familial- and community-level barriers impede its availability and acceptability.
Substances chimiques
Analgesics, Opioid
0
Opium
8008-60-4
Methadone
UC6VBE7V1Z
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
419-429Informations de copyright
© 2021 Australasian Professional Society on Alcohol and other Drugs.
Références
United Nations Office on Drug and Crime. World Drug Report 2020. United Nations publication, 2020, Sales No. E.20.XI.6.
Iran MoH. Islamic Republic of Iran AIDS Progress Report on Monitoring of the United Nations General Assembly Special Session on HIV and AIDS, 2018.
Amin-Esmaeili M, Rahimi-Movaghar A, Sharifi V et al. Epidemiology of illicit drug use disorders in Iran: prevalence, correlates, comorbidity and service utilization results from the Iranian mental health survey. Addiction 2016;111:1836-47.
Amin-Esmaeili M, Rahimi-Movaghar A, Gholamrezaei M, Razaghi EM. Profile of people who inject drugs in Tehran, Iran. Acta Med Iran 2016;54:793-805.
Malekinejad M, Navadeh S, Lotfizadeh A, Rahimi-Movaghar A, Amin-Esmaeili M, Noroozi A. High hepatitis C virus prevalence among drug users in Iran: systematic review and meta-analysis of epidemiological evidence (2001−2012). Int J Infect Dis 2015;40:116-30.
Rahimi J, Gholami J, Amin-Esmaeili M et al. HIV prevalence among people who inject drugs (PWID) and related factors in Iran: a systematic review, meta-analysis and trend analysis. Addiction 2020;115:605-22.
Momtazi S, Noroozi A, Rawson RA. An overview of Iran drug treatment and harm reduction programs. In: El-Guebaly N, Carrà G, Galanter M, eds. Textbook of addiction treatment: international perspectives. Milano: Springer, 2015. https://doi.org/10.1007/978-88-470-5322-9_25.
Harm Reduction International (HRI). What is harm reduction? A position statement from the International Harm Reduction Association, London, United Kingdom, English. 2010. Available at: https://www.hri.global/files/2010/08/10/Briefing_What_is_HR_English.pdf (accessed 1 March 2021).
Rahimi-Movaghar A, Amin-Esmaeili M, Shadloo B, Noroozi A, Malekinejad M. Transition to injecting drug use in Iran: a systematic review of qualitative and quantitative evidence. Int J Drug Policy 2015;26:808-19.
Rahimi-Movaghar A, Noroozi A, Page K et al. Transition to and away from injecting drug use among young drug users in Tehran, Iran: a qualitative study. Iran J Psychiatry Beh Sci 2017;11:1-10.
Koozegar M, Shahesmaeili A, Noroozi M. Transition from first drug use to regular injection among people who inject drugs in Iran. Addict Health 2018;10:32-40.
Ghane T, Zamani N, Hassanian-Moghaddam H, Beyrami A, Noroozi A. Lead poisoning outbreak among opium users in the Islamic Republic of Iran, 2016-2017. Bull World Health Organ 2018;96:165-72.
Amin-Esmaeili M, Rahimi-Movaghar A, Haghdoost AA, Mohraz M. Evidence of HIV epidemics among non-injecting drug users in Iran: a systematic review. Addiction 2012;107:1929-38.
Iran Drug Control Headquarter (DCHQ). Macro- policies of Drug Control. Communicated by Iran Supreme Leader on 1385.7.10, 2006. Available at: http://farsi.khamenei.ir/news-content?id=32758 (accessed 1 December 2020).
Mokri A, Shahraki MA, Yaghouni M. Substitution treatment with tincture of opium: preliminary results of an open label clinical trial in Iran. Abstract Book of International Harm Reduction Association (IHRA) Conference, Warsaw 2007, pp. 115-116.
Mokri A. One-year outcomes of opium tincture-assisted treatment (opitinc) among people who use opioids. Second revision. Iranian National Center for Addiction Studies, Final report of research project, 2010. [In Persian]
White WL. Congress 60: an addiction recovery community within the Islamic Republic of Iran. Alcohol Treat Q 2015;33:328-47.
Ekhtiari H, Noroozi A, Farhoudian A et al. The evolution of addiction treatment and harm reduction programs in Iran: a chaotic response or a synergistic diversity? Addiction 2020;115:1395-403.
Carrieri MP, Amass L, Lucas GM, Vlahov D, Wodak A, Woody GE. Buprenorphine use: the international experience. Clin Infect Dis 2006;43:S197-215.
Smye V, Browne AJ, Varcoe C, Josewski V. Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: an intersectional lens in the Canadian context. Harm Reduct J 2011;8:17.
Fairbairn N, Ross J, Trew M et al. Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline. CMAJ 2019;191:E1049-56.
Jegu J, Gallini A, Soler P, Montastruc JL, Lapeyre-Mestre M. Slow-release oral morphine for opioid maintenance treatment: a systematic review. Br J Clin Pharmacol 2011;71:832-43.
Malekinejad M, Vazirian M. Transition to injection amongst opioid users in Iran: implications for harm reduction. Int J Drug Policy 2012;23:333-7.
Radfar SR, Cousins SJ, Shariatirad S, Noroozi A, Rawson RA. Methamphetamine use among patients undergoing methadone maintenance treatment in Iran; a threat for harm reduction and treatment strategies: a qualitative study. Int J High Risk Behav Addict 2016;5:e30327.
Nikoo M, Nikoo N, Anbardan SJ et al. Tincture of opium for treating opioid dependence: a systematic review of safety and efficacy. Addiction 2017;112:415-29.
Jahani Dolatabad R, Asadi A, Jahani Dolatabad E, Mosivand J. The relationship between the development and amount of credits and funds of Tehran metropolis. J Reg Plann 2016;6:117-28.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101.
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2014;2:CD002207.
Gryczynski J, Jaffe JH, Schwartz RP et al. Patient perspectives on choosing buprenorphine over methadone in an urban, equal-access system. Am J Addict 2013;22:285-91.
Gartry CC, Oviedo-Joekes E, Laliberté N, Schechter MT. NAOMI: the trials and tribulations of implementing a heroin assisted treatment study in North America. Harm Reduct J 2009;6:2.
Strang J, Groshkova T, Metrebian N. New heroin-assisted treatment. Recent evidence and current practices of supervised injectable heroin treatment in Europe and beyond. Lisbon: European Monitoring Center for Drug and Drug Addiction, 2012. Available at: https://www.emcdda.europa.eu/system/files/publications/690/Heroin_Insight_335259.pdf (accessed 1 December 2020).
Hojjat SK, Rezaei M, Mohamadipoor M, Norozi Khalili M, Danesh M, Hatami S. The comparison of retention in three methods with methadone, opium and buprenorphine in patients admitted to addiction treatment centers. J North Khorasan Univ Med Sci 2016;8:245-56. [In Persian].
Kheradmand A, Fazeli A, Mazaheri Meybodi A. Comparing the effects of methadone, buprenorphine, and opium tincture maintenance therapy on sexual function. Addict Health 2019;11:120-8.
Eder H, Jagsch R, Kraigher D, Primorac A, Ebner N, Fischer G. Comparative study of the effectiveness of slow-release morphine and methadone for opioid maintenance therapy. Addiction 2005;100:1101-9.
Mitchell TB, White JM, Somogyi AA, Bochner F. Slow-release oral morphine versus methadone: a crossover comparison of patient outcomes and acceptability as maintenance pharmacotherapies for opioid dependence. Addiction 2004;99:940-5.
Verthein U, Beck T, Haasen C, Reimer J. Mental symptoms and drug use in maintenance treatment with slow-release oral morphine compared to methadone: results of a randomized crossover study. Eur Addict Res 2015;21:97-104.
Oviedo-Joekes E, Brissette S, Marsh DC, Lauzon P, Guh D et al. Diacetylmorphine versus methadone for the treatment of opioid addiction. N Engl J Med 2009;361:777-86.
Oviedo-Joekes E, Guh D, Brissette S, Marchand K, MacDonald S et al. Hydromorphone compared with diacetylmorphine for long-term opioid dependence: a randomized clinical trial. JAMA Psychiat 2016;73:447-55.
D'Ippolito M, Lundgren L, Amodeo M, Beltrame C, Lim L, Chassler D. Addiction treatment staff perceptions of training as a facilitator or barrier to implementing evidence-based practices: a national qualitative research study. Subst Abus 2015;36:42-50.
Giang V, Thulien M, McNeil R, Sedgemore K, Anderson H, Fast D. Opioid agonist therapy trajectories among street entrenched youth in the context of a public health crisis. SSM Popul Health 2020;11:100609.
Bagley SM, Hadland SE, Carney BL, Saitz R. Addressing stigma in medication treatment of adolescents with opioid use disorder. J Addict Med 2017;11:415-6.
Feder KA, Krawczyk N, Saloner B. Medication-assisted treatment for adolescents in specialty treatment for opioid use disorder. J Adolesc Health 2017;60:747-50.
Doukas N. Perceived barriers to identity transformation for people who are prescribed methadone. Addict Res Theor 2011;19:408-15.
Uebelacker LA, Bailey G, Herman D, Anderson B, Stein M. Patients' beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-assisted therapy following inpatient opioid detoxification. J Subst Abuse Teat 2016;66:48-53.
Bell J. The global diversion of pharmaceutical drugs. Opiate treatment and the diversion of pharmaceutical opiates: a clinician's perspective. Addiction 2010;105:1531-7.
Institute of Medicine (US). Methadone diversion control. Committee on Federal Regulation of methadone treatment. In: Rettig RA, Yarmolinsky A, eds. Federal Regulation of methadone treatment. Washington, DC: National Academies Press, 1995. Available at:. https://www.ncbi.nlm.nih.gov/books/NBK232116/ (accessed 1 December 2020).
Lofwall MR, Walsh SL. A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med 2014;8:315-26.
Molfenter T, Fitzgerald M, Jacobson N, McCarty D, Quanbeck A, Zehner M. Barriers to buprenorphine expansion in Ohio: a time-elapsed qualitative study. J Psychoactive Drugs 2019;51:272-9.