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Heroin Addiction and Related Clinical Problems: 2024, 26, 58

Need for opioid agonist therapy among opioid users of open drug scenes

Heike Zurhold, Silke Kuhn, Jens Reimer, and Uwe Verthein

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2024-58

Summary: Background. In Germany, the number of patients in opioid agonist therapy (OAT) remains stable since many years. For this reason, the major aim of the study was to evaluate the OAT need among the group of individuals with opioid dependence. Secondary objective was the identification of reasons for having discontinued a former OAT or for never having initiated OAT. Methods. A cross-sectional study with a mixed-method approach was conducted. With eligible opioid dependent persons (18 years+, not in OAT at least since 6 months) a quantitative survey and accompanying qualitative interviews have been carried out. The study was realised in the two German cities Hamburg and Frankfurt, and in three smaller German cities. Study participants were recruited in drug consumption rooms and through streetworkers and drug counselling services. Results. A total of 233 participants were included in the survey, and more than half were male (67.4 %). Almost 70 % had ever been in OAT, and in 46 % treatment retention was only up to one year. Previous OAT was mainly discontinued because of the desire to become abstinent (39%), the lack of take-home medication (32%), and insufficient flexibility of the treatment procedures (19%). In the qualitative interviews with 27 participants negative side effects from the medicaments were mentioned for OAT discontinuation. Among the 30% of the respondents never been in OST the major obstacle was their principle refusal of OAT (40%). As regards OAT needs, less than half of former OAT patients (45.6 %) and very few respondents without any OAT (14.1 %) expressed their need for OAT. Conclusions. There is a group of opioid users who were not willing to undergo OAT. If OAT uptake is accepted, treatment has to ensure take-home prescription and participation in the doctor’s decisions about the OAT medication, dosage and duration.

Keywords: Opioid agonist therapy(OAT); discontinuation; needs and barriers to OAT; open drug scene; cross-sectional survey; qualitative interviews