Commentary on Metrebian et al (2015): What is addiction treatment research about? Some comments on the secondary outcomes of the Randomized Injectable Opioid Treatment Trial

Addiction ◽  
2015 ◽  
Vol 110 (3) ◽  
pp. 491-493 ◽  
Author(s):  
Ambros Uchtenhagen
Keyword(s):  
Addiction Treatment ◽  
Treatment Trial ◽  
Opioid Treatment ◽  
Treatment Research ◽  
Secondary Outcomes

Limits of Evidence – the Case of Psychosocial Interventions in a Swedish Review of Maintenance Treatment Research

2009 ◽  
Vol 26 (4) ◽  
pp. 399-414 ◽  
Author(s):  
Mats Ekendahl
Keyword(s):  
Addiction Treatment ◽  
Maintenance Treatment ◽  
Scientific Evidence ◽  
Political Legitimacy ◽  
Psychosocial Interventions ◽  
Psychosocial Treatment ◽  
State Agency ◽  
Preliminary Review ◽  
Opiate Addiction ◽  
Treatment Research

In Sweden, maintenance treatment (MT) with methadone has been a controversial exception to drug-free treatment. However, efficacy, prescription control and the provision of simultaneous psychosocial treatment (PST) have provided MT with political legitimacy. This view, notably stressing that PST is an important complement to medication, was presented in central Swedish policy documents that paved the way for less strict MT regulations in 2005. Aim The present study aims to analyse how the various stakeholders involved in this policy process described and evaluated the efficacy and legitimacy of PST within the framework of the MT discussion. Data & Method The data consists of a document authored by a state agency (a preliminary review of MT research) and various stakeholders' written commentaries on it. different representations of PST (so-called constructions) were coded thematically and analysed using discourse analytical concepts. Results The results show that stakeholders' constructions of PST draw on different discourses related to the governance of Swedish opiate addiction treatment. Four constructions were identified, PST as: “mere complement” (narrow empirical discourse); “underrated intervention” (practitioner discourse); “preferred intervention” (ideological discourse) and “complex intervention” (antireductionist discourse). The study illustrates how the narrow empirical discourse's construction of PST as a mere complement was challenged by the three other discourses, but shows that the former remained the dominant influence on subsequent MT regulations. It also highlights that references to beliefs and alleged facts are intertwined in stakeholders' rhetorical efforts to assign meaning to PST. This suggests that science and ideology are interrelated in policy discussions on opiate addiction treatment, and that firm conclusions about the value of help interventions rely as much on scientific evidence as on strategic argumentation.

scholarly journals Reentry after Addiction Treatment: Research or Retrain?

2009 ◽  
Vol 110 (6) ◽  
pp. 1423-1424 ◽  
Author(s):  
Paul H. Earley ◽  
Arnold J. Berry
Keyword(s):  
Addiction Treatment ◽  
Treatment Research

scholarly journals Rural opioid treatment program patient perspectives on take-home methadone policy changes during COVID-19: a qualitative thematic analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ximena A. Levander ◽  
Kim A. Hoffman ◽  
John W. McIlveen ◽  
Dennis McCarty ◽  
Javier Ponce Terashima ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
Addiction Treatment ◽  
The United States ◽  
Patient Perspectives ◽  
Transmission Risk ◽  
Normal Person ◽  
Policy Changes ◽  
Total N ◽  
Opioid Treatment ◽  
Individualized Care

Abstract Background In the United States, methadone for opioid use disorder (OUD) is highly regulated. Federal agencies announced guidelines in March 2020 allowing for relaxation of take-home methadone dispensing at opioid treatment programs (OTPs) to improve treatment access and reduce COVID-19 transmission risk during the public health emergency. We explored patient perspectives at three OTPs serving rural communities on how take-home policy changes were received and implemented and how these changes impacted their addiction treatment and recovery. Methods We completed semi-structured individual qualitative interviews in 2 phases: (1) August–October 2020 and (2) November 2020–January 2021 (total n = 46), anticipating possible policy changes as the pandemic progressed. We interviewed patients with OUD enrolled at 3 rural OTPs in Oregon. Participants received varying take-home methadone allowances following the COVID-19-related policy changes. All interviews were conducted via phone, audio-recorded, and transcribed. We conducted a thematic analysis, iteratively coding transcripts, and deductively and inductively generating codes. Results The 46 participants included 50% women and 89% had Medicaid insurance. Three main themes emerged in the analysis, with no differences between study phases: (1) Adapting to changing OTP policies throughout the pandemic; (2) Recognizing the benefits, and occasional struggles, with increased take-home methadone dosing; and (3) Continuing policies and procedures post-pandemic. Participants described fears and anxieties around ongoing methadone access and safety concerns prior to OTP policy changes, but quickly adapted as protocols soon seemed “natural.” The majority of participants acknowledged significant benefits to increased take-homes independent of reducing COVID-19 infection risk including feeling “more like a normal person,” improved recovery support, reduced time traveling, and having more time with family and for work. Looking to a post-pandemic future, participants thought some COVID-19-related safety protocols should continue that would reduce risk of other infections, make OTP settings less stressful, and result in more individualized care. Conclusions As the pandemic progressed, study participants adapted to rapidly changing OTP policies. Participants noted many unanticipated benefits to increased take-home methadone and other COVID-19 protocols including strengthened self-efficacy and recovery and reduced interpersonal conflict, with limited evidence of diversion. Patient perspectives should inform future policies to better address the ongoing overdose epidemic.

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