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. 2023 Nov 1;20(1):162.
doi: 10.1186/s12954-023-00896-6.

Supervised on-site dosing in injectable opioid agonist treatment-considering the patient perspective. Findings from a cross-sectional interview study in two German cities

Zoe Friedmann  1 , Hans-Tilmann Kinkel  2 , Claudia Kühner  3 , Andreas Zsolnai  3 , Inge Mick  4 , Annette Binder  5   6
Affiliations

Supervised on-site dosing in injectable opioid agonist treatment-considering the patient perspective. Findings from a cross-sectional interview study in two German cities

Zoe Friedmann et al. Harm Reduct J. .

Abstract

Background: Injectable opioid agonist treatment (iOAT) is an effective option to support people living with opioid use disorder (OUD) who have not sufficiently benefitted from oral OAT. However, iOAT has been criticised based on theoretical and practical grounds for its dosing policies: Current regulations demand supervised, on-site application and require patients to frequently visit their treatment facility. The current study aims to investigate how patients experience on-site application and derive strategies to enhance the acceptability and effectiveness of iOAT-delivery.

Methods: This article is based on semi-structured interviews with 27 individuals currently or previously in iOAT in two German outpatient iOAT-clinics. We undertook an inductive qualitative content analysis, which included blinded, independent coding and the analysis of individual cases.

Results: Comments regarding on-site application and daily visits to the clinic were grouped into positive and negative aspects, iOAT as the best alternative option, facilitators of daily visits, and suggestions for improvement. Positive aspects took the factors stability and social support in regard. Negative aspects ranged from general inconveniences to major impediments to individuals' daily lives and towards achieving psychosocial goals. Participants reported rigorous adherence to iOAT's treatment regime, often due to a perceived lack of alternative options. Meeting iOAT's demands was eased by the patients' coping-strategies and through facilitating measures implemented by iOAT-clinics. Despite acknowledgement of the potential detriments from easing regulations, take-home arrangements were frequently suggested by participants to improve iOAT.

Conclusions: Being required to attend the clinic for supervised iOAT-application is not experienced uniformly. While clinics can support their patients to cope with strict regulations, alternative approaches to iOAT-application should be considered to accommodate patients' individual needs. Examples from other treatment modalities (e.g., remote supervision and delivery services) might aid to reconcile individualisation while providing adequate safety measures and improve iOAT in the long term.

Keywords: Dosing policies; Injectable opioid agonist treatment; Opioid use disorder; Patient perspective; Qualitative research; Take-home doses.

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Conflict of interest statement

ZF: Financial and non-monetary stipend from Studienstiftung des Deutschen Volkes (scholarship program from the German government). HK: Medical head and director of an outpatient clinic for addiction medicine (Praxiskombinat Neubau Berlin); Speaker's fees from Accente BizzComm GmbH, AbbVie Deutschland GmbH & Co. KG, and GILEAD Sciences GmbH; conference travel and attendance fees from GILEAD Sciences GmbH. CK: Psychologist at an outpatient clinic for addiction medicine (Schwerpunktpraxis für Suchtmedizin Stuttgart). AZ: Medical head and director of an outpatient clinic for addiction medicine (Schwerpunktpraxis für Suchtmedizin Stuttgart). IM: Senior physician in general adult psychiatry (including care for addictive behaviours) at Charité Berlin. AB: Member of Deutsche Gesellschaft für Suchtforschung und Suchttherapie e.V. (German society of addiction research and addiction therapy); medical residency in addiction medicine at Medical University Hospital Tuebingen.

Figures

Fig. 1
Fig. 1
The major category “daily visits” was used to guide the current article and is shown with its subcategories
See this image and copyright information in PMC

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