Risk factors associated with noncompliance with methadone substitution therapy (MST) and relapse among chronic opiate users in an Outer London community

Abstract

Aims: The purpose of this study was to identify the risk factors associated with noncompliance with methadone substitution therapy (MST) and hence relapse in chronic opiate-dependent users, as this has major clinical implications especially in community-based detoxification programmes.

Background: Community mental health nurses (CMHNs) and other health/social care professionals need to be aware of the main risk factors associated with MST noncompliance among long-term opiate users living within their catchment areas. The sex-matched patterns of biopsychosocial risk factors can be useful predictors of the ability of clients to comply with MST and their likelihood to complete the detoxification programme. A knowledge of the patterns of these high-risk factors also allows the care professionals to: (1) draw-up or re-draw care contracts that reflect their patients' biopsychosocial circumstances; (2) initiate much broader, client-centred, relapse prevention strategies; (3) select suitable patients for specialized detoxification contracts; and (4) modify the care approach from detoxification to maintenance contracting particularly for clients with low predicted scores for the former contract-type.

Methods: As successfully demonstrated in this semi-quantitative descriptive investigation, identification of these sex-typed biopsychosocial high-risk factors can easily be undertaken during assessment and when the clients attend regular review. In this study, numerical information was gathered during personal face-to-face interviews, and was supplemented with that contained in past multidisciplinary case notes.

Results: Overall, the medication noncompliant female clients were associated with personality trait, decreased educational expectations, everyday life stresses, ambivalent thoughts, social company availability, comorbidity, boredom, and family-related conflicts; whereas the noncompliant male clients were associated with poor motivation, fashion and reputation, peer association, uncontrollable drug-cravings, drug availability, major life events, too stringent prescribing/poor client-centred care package, heavy intravenous users, young polydrug users, and triple users.

Conclusions: These findings have important nursing practice connotations. This study is advocating the routine identification of biopsychosocial high-risk factors associated with MST noncompliance by all CMHNs working with chronic opiate-dependent users.