Background: The misuse and addiction to opioids are one of the major health and social problem that is associated with an increase in morbidity and mortality. Both Buprenorphine (BUP) and Methadone (MET) are FDA-approved treatments for opioid dependence. This longitudinal study is to determine the effects of BUP and MET on hypertension in patients with opioid dependence using a Generalized Estimating Equation(GEE) Model. Methods: The data is from National Drug Abuse Treatment Clinical TrialsNetwork (CTN) protocol CTN-0027. This is a randomized study of 1,934 opioid dependence participants seeking treatment that followed for up to 32 weeks. A total of1,284 males and 631 females participated at the Baseline (visit1) of the study. At the endof 32 weeks (10 visits), 499 males and 243 female patients completed the study. Blood pressure of all the patients was checked at every visit beginning visit 1 to visit 10. For this analysis, the dependent variable was hypertension which was defined as having asystolic blood pressure higher than 140 mmHg and/or a diastolic blood pressure higher than 90 mmHg. These participants were randomly assigned to receive BUP (n= 740) or MET (n= 529). The GEE model with exchangeable correlation was used to determine the efficacy of both the drugs on hypertension. The analysis was performed using PROCGENMOD in SAS 9.4. Results: Time increased the odds of hypertension (adjusted odds ratio (aOR): 1.04, 95% confidence interval (CI): 1.02-1.06, pConclusion: Findings suggest that BUP had a slightly less chance of causing hypertension among patients with opioid dependence comparing with MET controlling for other risk factors, but neither one of Page 54 2017 Appalachian Student Research Forum them had any significant effect on hypertension among patients with opioid dependence. Further analysis will be essential to detect gender x treatment interaction.

Bakgrund: Heroin är en opiat ursprungen från opiumvallmon och är starkt förknippad med beroende och död. När heroin och andra kortverkande opiater binder in till μ-opioidreceptorer i hjärnan sker en ökad frisättning av signalsubstansen dopamin och en stark känsla av eufori infinner sig. Vid upprepat intag sker förändringar i hjärnan; belöningseffekten minskar medan antibelöningseffekterna ökar och cravings och abstinensymptom blir allt tydligare vid frånvaro av drogen. Vid läkemedelsassisterad rehabilitering vid opiatberoende (LARO) används förutom psykosocial behandling även långverkande opioider såsom opioidagonisten metadon och den partiella opioidagonisten buprenorfin, för att återställa homeostasen och reducera cravings och abstinenssymptom som opioidberoendet har skapat. Metadon är effektivt vid beroendebehandling men dess risker begränsar dess användning. Buprenorfin har lägre överdospotential men eventuellt sämre effekt än metadon. Syfte: Syftet med denna litteraturstudie var att undersöka skillnad i effekt mellan buprenorfinpreparat och metadon vid behandling av opioidberoende. Metod: Arbetet är en litteraturstudie baserat på fem vetenskapliga studier vilka har erhållits via sökning i PubMed samt Cochrane Library. De aspekter som avhandlats är; fullföljande och retention av behandling, samtidigt sidomissbruk av opiater samt allvarliga incidenter och biverkningar. Resultat: De inkluderade studierna i denna litteraturstudie visade att metadon är bättre på att bevara patienter i behandling medan buprenorfin mer effektivt kan minska sidomissbruket av opiater. Ju högre doser som användes, desto fler deltagare stannade kvar i behandling och desto färre urinprover rapporterades positiva för sidomissbruk av opiater. Få allvarliga incidenter rapporterades från studierna. Slutsats: Både metadon och buprenorfinpreparaten har sina för- och nackdelar.  Då behandling med metadon tidigare bevisats vara mer riskfyllt bör buprenorfinpreparaten utgöra förstahandsval, men vid otillräcklig effekt bör byte till metadon ske. Detta överrensstämmer med riktlinjerna i Sverige idag. Dock tycks det finnas anledning att i framtida studier undersöka dos-effekt-samband för både dessa preparat, samt också att fokusera på den initiala fasen vid behandling med buprenorfin. / Background: Heroin is an opiate from the opium poppy which is strongly associated with dependence, overdose and death. When heroin and other opiates binds to the μ-opioid receptors located in the brain, dopamine is released from the ventral tegmental area and a strong feeling of euphoria arises. Continuous intake of opioids cause changes in the brain and the feeling of euphoria will be less distinct during drug intake. Instead, cravings and abstinence, will be more distinctive in absence of the drug and causes drug-abusers to continue to use the drug. The cravings and abstinence is due to an overactive HPA-axis and amygdala. This overactivity can be reduced by treatment with long lasting opioids that is used in treatment of opioid dependence. The development of opioid maintenance treatment started in the US during the early 1960s. A few years later, opioid dependent people could join the first opioid maintenance treatment program in Uppsala, Sweden. The opioid maintenance treatment involves both pharmacological and psychosocial treatment. There are two main substances available for opioid maintenance treatment in Sweden: methadone, a full μ-opioid receptor agonist and buprenorphine, a partial μ-opioid receptor agonist. Methadone has been proven to be very efficacious treating opioid dependence. However, the risk of overdose leading to respiratory depression, limits its usefulness. Buprenorphine on the other hand, has a lower risk of toxicity but may not have same efficacy as methadone. Aim: The purpose of this literature study is to examine the efficacy of buprenorphine versus methadone among patients in opioid maintenance treatment. Methods: Five different randomized, controlled trials were selected from PubMed and The Cochrane Library to be included in this literature study. To limit this degree project, four variables was selected: completion and retention in treatment, use of illicit opiates during treatment and adverse events associated with treatment medication. Results: According to the findings in the five studies, methadone can be considered as a better option than buprenorphine when it comes to retaining participants in treatment. However, buprenorphine is somewhat more effective reducing the illicit use of opiates. When both methadone and buprenorphine were used in higher doses, more participants stayed in treatment. Also, higher doses were associated with a lower portion of urine samples positive for illicit opiates. Few adverse events were documented from the studies. Conclusion: Both methadone and buprenorphine have advantages and disadvantages. Since treatment with methadone is more perilous, buprenorphine should be considered as first-line treatment. But if the clinical effect remains insufficient, a transition to methadone treatment should occur, all according to the guidelines of opioid maintenance treatment in Sweden. However, future studies should consider evaluating the relationship between dose and effect of buprenorphine and possibly also methadone. Furthermore, more focus should be added on the initiation phase of treatment with buprenorphine.

Bakgrund  Opioidepidemin som pågår ses som ett globalt folkhälsoproblem där ökad förskrivning av receptbelagda opioider spelar en central roll. Opioider kan orsaka lidande och i många fall en för tidig död. Patienter har ofta negativa upplevelser av sjukvården. Vårdpersonal saknar vanligen utbildning och upplever rädsla för att vårda denna patientgrupp. Syfte Syftet var att beskriva patienters upplevelser av opioidanvändning och opioidberoende. Metod En icke-systematisk litteraturöversikt utfördes. Med hjälp av relevanta sökord som bland annat “opioid related disorder”, “substance use disorder” och “patient perspective” för föreliggande syfte togs de inkluderade artiklarna fram från databaserna CINAHL och PubMed. För att säkerställa att artiklarna var av god kvalitet granskades de utifrån Sophiahemmets högskolas bedömningsinstrument. Därefter utfördes en integrerad analys som resulterade i fyra olika teman. Resultat Litteraturöversiktens resultat beskriver patienternas upplevelser av opioidanvändning och opioidberoende. Resultatet ger kunskap om patienternas upplevelser av att påbörja och avsluta användning av opioider, sambandet mellan smärta och opioidanvändning samt upplevelsen av stigmatisering. Även en kunskapsbrist kring opioiders beroendeframkallande effekt beskrivs i studien. Slutsats Resultatet av litteraturöversikten kan öka kunskap och förståelse kring betydelsen av vägledande och fullständig information som bör ges till patienter gällande opioider. Genom att informera om, samt öka patienternas förståelse om opioider kan detta förhoppningsvis minska risken att utveckla beroende. För att kunna garantera en hållbar utveckling ur ett holistiskt perspektiv är vårdpersonal i behov av lämpliga verktyg och förutsättningar för att kunna bidra till en säker behandling och god omvårdnad. / Background The ongoing opioid epidemic is seen as a global public health problem, where increased prescribing of prescription opioids has a significant role. Opioids can cause suffering and, in many cases, premature death. Patients often have negative experiences of healthcare. Nursing staff do not usually have enough education and experience fear of caring for this patient group. Aim The aim of this study was to describe patients' experiences of opioid use and opioid dependence. Method A non-systematic literature review was performed. Using relevant keywords such as “opioid related disorder”, “substance use disorder” and “patient perspective” for the present purpose, the included articles were retrieved from the CINAHL and PubMed databases. To ensure that the articles were of good quality, they were examined on the basis of Sophiahemmet University's assessment instrument. An integrated analysis was then performed, resulting in four different themes. Results The results of the literature review were based on 16 scientific articles of both qualitative and quantitative design. The results provide knowledge about patients' experiences of living with opioids, the connection between pain and opioid use and the experience of stigma. A lack of knowledge about the addictive effect of opioids is also described in the study. Conclusions The results of the literature review can increase knowledge and consideration about the importance of guiding and complete information that should be given to patients regarding opioids. By informing them about and increasing patients' understanding of opioids, this can hopefully reduce the risk of developing addiction. In order to guarantee sustainable development from a holistic perspective, care staff need suitable tools and conditions to be able to contribute to safe treatment and good nursing.

Bakgrund: Internationell forskning visar på problematik kring smärtlindring av patienter med opiatberoende. Det framkommer att otillräckliga doser analgetika administreras till denna patientgrupp och att vårdpersonal saknar kunskap gällande smärtlindring av patienter med opiatberoende. Forskning visar även att vårdpersonal kan ha en negativ inställning till drogberoende patienter och ofta misstror deras motiv gällande förfrågan om analgetika. Vidare visar forskningen att denna patientgrupp upplever sig få en sämre vård än patienter utan drogberoende. Syfte: Studiens syfte var att belysa faktorer som har inverkan på smärtlindringen av patienter med opiatberoende på en beroendeavdelning. Metod: Empirisk studie med deskriptiv kvalitativ ansats baserad på strukturerade intervjuer med fyra sjuksköterskor verksamma vid en beroendeavdelning i en svensk storstad. Data analyserades genom manifest innehållsanalys. Resultat: Under analysen utkristalliserades tre kategorier och elva underkategorier, vilka beskriver faktorer som har inverkan på smärtlindringen av patienter med opiatberoende: (I) Förhållningssätt omfattar (1) Att inte döma och (2) Bemötande. (II) Förutsättningar omfattar (3) Restriktivitet, (4) Tolerans, (5) Ångest, (6) Personalbrist och (7) Kunskap. (III) Metoder omfattar (8) Smärtskattning, (9) Lindra ångest, (10) Kämpa för patienten och (11) Interprofessionalitet. Slutsats: Studiens resultat tyder på att ett respektfullt och tillmötesgående bemötande gentemot patienterna utgör en central roll i smärtbehandlingen. Vidare visar studien att sjuksköterskornas möjlighet att smärtlindra patienter i beroendevården begränsas av kunskapsluckor, restriktiva regler, resursbrist samt en patientgrupp som är svår att smärtlindra. Studiens resultat tyder på vikten av att lindra patienternas ångest samt vinsterna med ett interprofessionellt samarbete kring smärtlindring. Klinisk betydelse: Studien kan öka medvetenheten kring de hinder som identifierats för smärtlindring av patienter med opiatberoende. Sjuksköterskornas metoder i den aktuella studien skulle kunna utnyttjas i betydligt större utsträckning i beroendevården och i andra vårdkontexter vilket därigenom skulle bespara patientgruppen onödigt vårdlidande. / Background: International research indicates several difficulties concerning pain relief for patients with opioid dependence. It appears that inadequate doses of analgesics are administered to patients with substance dependence and that health professionals lack knowledge regarding pain management of patients with opioid dependence. Research also shows that health professionals may have a negative attitude towards drug-dependent patients and often distrust their motives regarding request for analgesics. Furthermore, research shows that opioid dependent patients feel that they get poorer care than patients without drug addiction. Aim: The aim of the study was to examine factors that have an impact on pain relief in patients with opioid dependence from nurses’ perspective at a drug dependence treatment clinic. Method: Empirical study with descriptive qualitative approach based on structured interviews with four nurses working at a drug dependence treatment clinic in a major Swedish city. Data were analyzed with manifest content analysis. Results: During the analysis three categories and eleven subcategories emerged: (I) Attitude is comprised of (1) To not judge, and (2) Treatment. (II) Conditions is comprised of (3) Restrictivity, (4) Tolerance (5) Anxiety, (6) Staff shortage and (7) Knowledge. (III) Methods is comprised of (8) Pain assessment, (9) Relieving anxiety, (10) Fighting for the patient, and (11) Interprofessionalism. Conclusion: The study's results suggest that a respectful attitude towards patients plays a key role in pain management. Furthermore, the study shows that the nurses’ opportunity to relieve pain of patients in addiction treatment is limited by gaps in knowledge, restrictive regulations, lack of resources and patients that are difficult to pain relieve. The study's findings indicate the importance of alleviating the patients' anxiety and the benefits of interprofessional collaboration regarding pain treatment. Clinical significance: This study can increase the awareness of the barriers to pain management identified for patients with opioid dependence. Nursing practice in the current study could be used to a much greater extent in addiction services and other care contexts and thereby save the patients unnecessary suffering.

Bakgrund Smärta är en subjektiv upplevelse och smärtbehandling bör därför utformas olika beroende på individens smärtupplevelse. Att lindra lidande och smärtbehandla alla patienter där behovet finns är en del av sjuksköterskans arbetsuppgifter. Smärtbehandling hos patienter med ett samtidigt opioidberoende kan upplevas problematiskt och som ett hinder i vårdandet av denna patientgrupp. Sjuksköterskors attityder till att smärtbehandla opioidberoende patienter kan grunda sig i egna erfarenheter och personliga åsikter där attityden kan påverka mötet med patienter och vårdandet av dessa. Syfte Syftet var att belysa sjuksköterskors attityder till smärtbehandling för opioidberoende patienter. Metod Icke systematisk litteraturöversikt användes som metod för att besvara syftet med stöd av 17 vetenskapliga artiklar. Artikelsökning genomfördes i PubMed och CINAHL Complete. Resultat Genomförd litteraturöversikt visade att sjuksköterskor hade negativa attityder till att vårda och smärtbehandla opioidberoende patienter. Sjuksköterskor upplevde problematik kring tillit och partnerskap i uppbyggandet av god vårdrelation då patienten var opioidberoende och ansåg att mötet med dessa patienter kunde bli hotfullt och påverkat av manipulativt beteende. Sjuksköterskors tidigare erfarenheter och personliga inställning till missbruk påverkade vårdandet. De upplevda problemen gällande att smärtbehandla opioidberoende patienter ofta grundade sig i kunskapsbrist hos sjuksköterskor. Kunskapsbristen genererade otrygghet i beslutsfattande, bemötande och vårdande av patienter med opioidberoende och samtidig smärta. De sjuksköterskor som hade mer erfarenhet av patientgruppen tenderade uppleva mer positiva attityder och en känsla av säkerhet gällande både bemötande och smärtbehandling. Sjuksköterskor beskrev vikten av god och formell utbildning och behov av organisatoriskt stöd i vårdandet. Slutsats Litteraturöversiktens resultat tyder på att sjuksköterskor brister i sin utbildning gällande vårdandet av patienter med missbruk i samband med smärtbehandling. Sjuksköterskornas kunskap och erfarenhet ligger till grund för hur omvårdnaden och mötet med patientgruppen utformas. Framtagna riktlinjer och stödmodeller krävs på en organisatorisk nivå för vårdande av missbrukande patienter i samband med smärtbehandling. / Background Pain is a subjective experience. Relieving suffering and treating all patients where the need arises is a part of the nurse's duties. Pain treatment for patients with concomitant opioid dependence can be experienced as problematic. The nurse's attitudes towards treating opioid dependent patients may be based on individual experiences and personal opinions, where their attitude can influence the meeting with patients and their care. Aim The aim was to explore nurses’ attitudes to pain treatment for opioid dependent patients. Method Non-systematic literature review was used as a method to answer the purpose with the support of 17 scientific articles. The article search was performed in PubMed and CINAHL Complete. Results The literature review showed that nurses had negative attitudes towards caring for and treating opioid dependent patients. Nurses experienced problems with trust and partnership when the patient was opioid dependent and considered that interactions with these patients could be threatening and influenced by manipulative behavior. Nurses' previous experiences and personal attitudes towards addiction affected the care. Problems regarding pain treatment of opioid dependent patients were often based on a lack of knowledge, which generated insecurity in decision making, treatment and care of the patient group. Nurses who had more experience of the patient group tended to experience more positive attitudes and a sense of security regarding both care treatment and pain treatment. Good and formal education and need for organizational support in care of the patient group were indicated. Conclusions The results indicate that there is a lack of training among nurses in the care of addicted patients in connection with pain treatment. The nurses' knowledge and experience form the basis of how the nursing and meeting with the patient group looks like. Developed guidelines are required at an organizational level for addicted patients in connection with pain treatment.

Opium, the dried resin obtained from the unripe seedpods of the poppy flower, has been used for medicinal and euphoric purposes since ancient times. Morphine, the main active ingredient of opium, and other clinically useful opioid analgesics all mediate their effects through activating the mu opioid receptor. Studies involving the mu opioid receptor knockout mice showed that the interaction with the mu opioid receptor is also responsible for many notorious side effects associated with these drugs including dependence and addiction. Therefore, selective antagonists for the mu opioid receptor are needed to study its function in drug abuse and addiction. Previously, based on molecular modeling studies and the “message-address” concept, a series of 14-O-substituted naltrexone derivatives were designed and synthesized. These compounds carried an ester-linked heteroaromatic substitution at the 14-position of naltrexone which was designed to interact with the putative “address” site, that was identified in the mu opioid receptor through molecular modeling studies. The lead compound of this series was determined to have a high affinity and selectivity for the mu opioid receptor. Because the 14-O-substituted naltrexone derivatives were not very stable, the ester linkage in these compounds was replaced by an amide one and a series of 14-N-substituted naltrexone derivatives were synthesized. The affinity and selectivity of these novel naltrexone derivatives were determined in a competitive radioligand binding assay. Interestingly, the 14-N-substituted naltrexone derivatives did not maintain the high selectivity of the 14-O-substituted series. It was hypothesized that the conformational constraint introduced by the amide linker was detrimental to the mu opioid receptor selectivity. Therefore, three 14-N-substituted naltrexone derivatives which carried more flexible linkages were synthesized and evaluated. The mu opioid receptor selectivity was not recovered by introducing rotational freedom into the linker. Some of these 14-N-substitued naltrexone derivatives were determined to be mu-kappa opioid receptor dual selective antagonists. Since the mu opioid receptor antagonists are effective at treating drug addiction, while growing evidence suggests that the kappa opioid receptor antagonists may be beneficial in lowering drug cravings, these novel mu-kappa opioid receptor dual selective antagonists may find unique clinical utility in the treatment of opioid dependence.

Background: In many countries, buprenorphine and methadone are licensed for the maintenance treatment (MT) of opioid dependence. Despite many short-term studies, little is known about the long-term (12-month) effects of these treatments in different settings, i.e. primary care-based (PMC) and specialized substitution centers (SSCs). Objectives: To describe over a period of 12 months: (1) mortality, retention and abstinence rates; (2) changes in concomitant drug use, somatic and mental health; and (3) to explore differences between different types of provider settings. Methods: 12-Month prospective-longitudinal naturalistic study with four waves of assessment in a prevalence sample of N= 2694 maintenance patients, recruited from a nationally representative sample of N= 223 substitution physicians. Results: The 12-month retention rate was 75%; the mortality rate 1.1%. 4.1% of patients became “abstinent” during follow-up. 7% were referred to drug-free addiction treatment. Concomitant drug use decreased and somatic health status improved. No significant improvements were observed for mental health and quality of life. When controlling for initial severity, small PMC settings revealed better retention, abstinence and concomitant drug use rates. Conclusion: The study underlines the overall 12-month effectiveness of various forms of agonist MT. Findings reveal relatively high retention rates, low mortality rates, and improvements in most 12-month outcome domains, except for mental health and quality of life. PMC settings appear to be a good additional option to improve access to MTs.

Lietuvoje asmenims, priklausomiems nuo opioidų, vis dažniau yra skiriamas gydymas stacionaruose ir farmakoterapija metadonu ar buprenorfinu. Tokiems pacientams visą parą skiriama slauga, todėl siekiant tobulinti slaugos paslaugų kokybę, svarbu žinoti, kaip slaugos veiksnius vertina patys pacientai, priklausomi nuo opioidų, ir slaugytojai, dirbantys priklausomybės ligų centruose, kokie slaugos veiksniai turi teigiamą arba neigiamą poveikį slaugos procesui ir pacientų lūkesčiams. Darbo tikslas. Išanalizuoti opioidinės priklausomybės pacientų lūkesčių tenkinimą slaugos procese. Tyrimo metodika. Atliktas empirinis kiekybinis tyrimas. Taikyti šie metodai: anoniminė anketinė apklausa pagal standartizuotus klausimynus (juos adaptuojant), statistinis duomenų apdorojimas ir medicininės literatūros analizė. Apklausa vykdyta dviejuose priklausomybės ligų centruose. Tyrime dalyvavo 266 pacientai (priklausomi nuo opioidų), kurie gydėsi priklausomybės ligų centruose, ir 71 slaugytojas iš šių gydymo įstaigų. Tyrimas atliktas vadovaujantis etikos principais. Tyrimo rezultatai. Nustatyta, kad labiausiai turintys įtakos pacientų lūkesčiams veiksniai yra šie: slaugytojų elgesys, jų sąžiningumas, geranoriškumas ir tolerantiškumas, aplinkos pritaikymas gydymui, informacijos apie gydymo ir slaugos svarbą ir vaistų vartojimą suteikimas, skiriamas dėmesys, bendravimas su pacientais ir jo šeimos nariais, pacientų ir jų asmeninių įpročių gerbimas. Tyrimo rezultatai parodė, kad pacientų lūkesčiams turi... [toliau žr. visą tekstą] / In Lithuania, persons who have opioid dependence are more often assigned to inpatient treatment and pharmacotherapy with methadone or buprenorphine. These patients are allocated with round the clock care service, therefore in order to improve the quality of care, it is important to find out how patients with opioid dependence and carers working in addiction recovery centres rate care aspects, what factors have a positive or negative impact on the process of care and on expectations of patients. Objective of the thesis. Analyze expectations in care process of patients with opioid dependence. Methods. Empirical quantitative research has been conducted. The following methods were applied: anonymous survey using standardized (adapted) questionnaires, processing of statistical data and analysis of medical literature. The survey was carried out in two Centres of Addictive Disorders. 266 patients (addicts on opioids), who were treated in Centres of Addictive Disorders, and 71 nurses from these medical institutions have participated in the research. The study was conducted in accordance with ethical principles. Findings. It was found that factors having most influence to expectations of patients are as follows: behaviour of nurses, their honesty, kindness and tolerance, adaptation of environment to treatment, providing information about importance of treatment and care, and usage of medicines, expressing attention, communication with patients and family members, respecting patients... [to full text]

Introduction: Breastfeeding offers the substance exposed mother and child potential short and long-term health benefits, with breast milk shown to alleviate the severity of Neonatal Abstinence Syndrome. Substance dependent women, however, have limited success establishing breastfeeding with physical, psychological and institutional factors cited as barriers. This study aimed to develop and test the feasibility of an evidence informed and theory based intervention to support continued breastfeeding for this group. Methods: The research was a two-phase feasibility study. Phase 1 informed intervention development using a mixed methodology approach which included (a) a comprehensive systematic literature review of breastfeeding support for women from disadvantaged groups (b) expert advisory group recommendations and (c) ‘think aloud’ verbal protocols with opioid dependent women. Phase 2 underpinned the evidence with the theoretical constructs of behaviour change, prior to testing the acceptability and implementation fidelity of the intervention in a feasibility study with an embedded small-scale randomised controlled trial. Results: Phase 1 identified the barriers to breastfeeding continuation as low maternal self-efficacy; neonatal feeding difficulties associated with withdrawal and unsupportive healthcare practices. Evidence and theory synthesis resulted in an integrated breastfeeding support model founded on practical, informational, psychological, person-centred and environmental components. Phase 2 demonstrated that the intervention was feasible to implement and acceptable to participants. The randomised controlled trial reported higher rates of continued breastfeeding and a greater level of maternal confidence in breastfeeding ability in the intervention group compared to the control group. Breastfed infants were less likely to require pharmacological management and had corresponding shorter durations of hospitalisation than formula fed infants. Conclusion: The research provided an original contribution to the development of a complex healthcare intervention which is meaningful to both existing research and clinical practice. The findings highlighted the potential of the intervention to support breastfeeding for the substance exposed mother and baby, which has wide ranging implications for the improved health and social equalities of this group.

Opioid addiction is a physical, mental, and social issue. The insidious habits and behaviors acquired while living an addictive lifestyle are more powerful than human comprehension, and the training required to release these strongholds are extreme to say the least. Capturing the lived experiences of this process is needed to increase understanding of the development that leads to transformation from active addict to addict in recovery. This phenomenological research study on the treatment experience of opioid addicts used a qualitative approach to gain understanding of this phenomenon. For this study, 15 research participants were selected. Their ages ranged from 21 to 30-years-old and they all successfully completed an adult substance abuse treatment program. All participants must have been in active recovery for a minimum of one year. The central question for this study is: what are the intrapersonal and interpersonal conflicts opioid addicts are presented with during their treatment process? By means of conducting and analyzing interview questions and utilizing the conflict resolution theories of human motivation, social identity theory, coordinated management of meaning theory, and relative deprivation theory, this study revealed that the overall essence of the treatment experience is the journey of identity transformation from active addict to addict in recovery through conflict management. The need to manage conflict in five specific areas was uncovered. They include identity formation, stigma, interpersonal relationships, group structure, and conflict styles. The participants’ shared experiences provide insight into identifying conflicts that need to be managed and resolved so recovery is achieved and sustained.