'Not at all what I had expected': Discontinuing treatment with extended-release naltrexone (XR-NTX): A qualitative study.

Analgesics, Opioid / therapeutic use Buprenorphine / therapeutic use Clinical Studies as Topic Delayed-Action Preparations / therapeutic use Female Humans Injections, Intramuscular Male Naltrexone / therapeutic use Narcotic Antagonists / therapeutic use Opioid-Related Disorders / drug therapy Qualitative Research
Extended-release naltrexone Opioid use disorder Patient experience Treatment discontinuation

Journal

Journal of substance abuse treatment
ISSN: 1873-6483
Titre abrégé: J Subst Abuse Treat
Pays: United States
ID NLM: 8500909

Informations de publication

Date de publication:
05 2022
Historique:
received: 19 07 2021
revised: 08 10 2021
accepted: 19 11 2021
pubmed: 7 12 2021
medline: 19 4 2022
entrez: 6 12 2021
Statut: ppublish

Résumé

Extended-release naltrexone (XR-NTX), an opioid antagonist, has demonstrated equal treatment outcomes, in terms of safety, opioid use, and retention, to the recommended OMT medication buprenorphine. However, premature discontinuation of XR-NTX treatment is still common and poorly understood. Research on patient experiences of XR-NTX treatment is limited. We sought to explore participants' experiences with discontinuation of treatment with XR-NTX, particularly motivation for XR-NTX, experiences of initiation and treatment, and rationale for leaving treatment. We conducted qualitative, semi-structured interviews with participants from a clinical trial of XR-NTX. The study participants (N = 13) included seven women and six men with opioid dependence, who had received a minimum of one and maximum of four injections of XR-NTX. The study team analyzed transcribed interviews, employing thematic analysis with a critical realist approach. The research team identified three themes, and we present them as a chronological narrative: theme 1: Entering treatment - I thought I knew what I was going into; theme 2: Life with XR-NTX - I had something in me that I didn't want; and theme 3: Leaving treatment - I want to go somewhere in life. Patients' unfulfilled expectations of how XR-NTX would lead to a better life were central to decisions about discontinuation, including unexpected physical, emotional, or mental reactions as well as a lack of expected effects, notably some described an opioid effect from buprenorphine. A few participants ended treatment because they had reached their treatment goal, but most expressed disappointment about not achieving this goal. Some also expressed renewed acceptance of OMT. The participants' motivation for abstinence from illegal substances generally remained. Our findings emphasize that a dynamic understanding of discontinuation of treatment is necessary to achieve a long-term approach to recovery: the field should understand discontinuation as a feature of typical treatment trajectories, and discontinuation can be followed by re-initiation of treatment.

Sections du résumé

BACKGROUND
Extended-release naltrexone (XR-NTX), an opioid antagonist, has demonstrated equal treatment outcomes, in terms of safety, opioid use, and retention, to the recommended OMT medication buprenorphine. However, premature discontinuation of XR-NTX treatment is still common and poorly understood. Research on patient experiences of XR-NTX treatment is limited. We sought to explore participants' experiences with discontinuation of treatment with XR-NTX, particularly motivation for XR-NTX, experiences of initiation and treatment, and rationale for leaving treatment.
METHODS
We conducted qualitative, semi-structured interviews with participants from a clinical trial of XR-NTX. The study participants (N = 13) included seven women and six men with opioid dependence, who had received a minimum of one and maximum of four injections of XR-NTX. The study team analyzed transcribed interviews, employing thematic analysis with a critical realist approach.
FINDINGS
The research team identified three themes, and we present them as a chronological narrative: theme 1: Entering treatment - I thought I knew what I was going into; theme 2: Life with XR-NTX - I had something in me that I didn't want; and theme 3: Leaving treatment - I want to go somewhere in life. Patients' unfulfilled expectations of how XR-NTX would lead to a better life were central to decisions about discontinuation, including unexpected physical, emotional, or mental reactions as well as a lack of expected effects, notably some described an opioid effect from buprenorphine. A few participants ended treatment because they had reached their treatment goal, but most expressed disappointment about not achieving this goal. Some also expressed renewed acceptance of OMT. The participants' motivation for abstinence from illegal substances generally remained.
CONCLUSION
Our findings emphasize that a dynamic understanding of discontinuation of treatment is necessary to achieve a long-term approach to recovery: the field should understand discontinuation as a feature of typical treatment trajectories, and discontinuation can be followed by re-initiation of treatment.

Identifiants

DOI: 10.1016/j.jsat.2021.108667 PMID: 34865937
pubmed: 34865937
pii: S0740-5472(21)00393-7
doi: 10.1016/j.jsat.2021.108667
pii:
doi:

Substances chimiques

Analgesics, Opioid 0
Delayed-Action Preparations 0
Narcotic Antagonists 0
Buprenorphine 40D3SCR4GZ
Naltrexone 5S6W795CQM

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

108667

Informations de copyright

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Auteurs

Ida Halvorsen Brenna (IH)

Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway. Electronic address: idbren@helse-bergen.no.

Anne Marciuch (A)

Department of Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway; Department of Medicine, University of Oslo, Oslo, Norway.

Bente Birkeland (B)

Department of Psychosocial Health, Faculty of Health and Sports Science, University of Agder, Kristiansand, Norway.

Marius Veseth (M)

Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.

Bente Røstad (B)

RIO-a Norwegian users' association in the field of alcohol and drugs, Oslo, Norway.

Else-Marie Løberg (EM)

Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway; Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.

Kristin Klemmetsby Solli (KK)

Department of Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway; Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway; Vestfold Hospital Trust, Toensberg, Norway.

Lars Tanum (L)

Department of Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway; Faculty for Health Science, Oslo Metropolitan University, Oslo, Norway.

Bente Weimand (B)

Department of Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway; Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Dépresseurs du système nerveux central › Stupéfiants › Analgésiques morphiniques › 'Not at all what I had expected':...
questionsmedicales.fr › Composés polycycliques › Hydrocarbures aromatiques polycycliques › Phénanthrènes › Morphinanes › Buprénorphine › 'Not at all what I had expected':...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › 'Not at all what I had expected':...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Systèmes de délivrance de médicaments › Préparations à action retardée › 'Not at all what I had expected':...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › 'Not at all what I had expected':...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Voies d'administration de substances chimiques et des médicaments › Injections › Injections musculaires › 'Not at all what I had expected':...
questionsmedicales.fr › Composés polycycliques › Hydrocarbures aromatiques polycycliques › Phénanthrènes › Morphinanes › Naloxone › Naltrexone › 'Not at all what I had expected':...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Antagonistes narcotiques › 'Not at all what I had expected':...
questionsmedicales.fr › Troubles mentaux › Troubles liés à une substance › Troubles liés à l'usage de substances psychotropes › Troubles liés aux opiacés › 'Not at all what I had expected':...
questionsmedicales.fr › Disciplines des sciences naturelles › Science › Recherche › Recherche empirique › Recherche qualitative › 'Not at all what I had expected':...