Goals: to focus on the Quality of life in clients of the substitution program according the duration of treatment at the Department of Addictology, 1. LF UK a VFN in Prague. Background: The topic of dissertation was chosen on the basis of a 16-year clinical experience of the author with the target group of clients in methadone substitution. I realized based on long-term observation, that clients go through certain stages of satisfaction with their lives. This may correspond with their functioning in the program. The theoretical part describes the substitution treatment for opiate dependence and quality of life concept. Methods: A total selection method was chosen. Data are collected using a standardized questionnaire World Health Organization - WHOQOL-BREF (short version). File: The research sample consists of 39 patients (out of total of 65 clients of Substitution centre, Department of Addictology First Faculty of Medicine, Charles University and General Teaching Hospital in Prague. Results: There were no significant differences in the quality of life in relation to the duration of treatment. The highest quality of life had clients in the category 2-5 years in the program. The lowest score gained clients in category over 5 years. Patients in category of 2 years received an average score. The...

Hintergrund: Die Datenlage zur Substitutionstherapie Opiatabhängiger ist defizitär. Vor diesem markant defizitären Erkenntnishintergrund erscheint es sinnvoll und notwendig, eine versorgungsepidemiologische Studie zur aktuellen Versorgungslage opiatabhängiger Substitutionspatienten durchzuführen, um offene Fragen zu klären. Hierfür haben wir ein mehrstufiges Forschungsprojekt unter dem Akronym COBRA initiiert. COBRA steht für "Cost-Benefit and Risk Appraisal of Substitution Treatments" und signalisiert, dass wir uns in umfassender Weise um eine Evaluation der Risiken, Vor- und Nachteile verschiedener Interventionsstrategien und Modalitäten in der Substitutions- und Versorgungspraxis Opiatabhängiger in Deutschland bemühen. Zielsetzungen des COBRA-Projekts sind: • Die Charakterisierung von bestehenden Einrichtungsformen und -modellen; • Die Charakterisierung von: – Merkmalen opiatabhängiger Patienten in diesen Einrichtungen (Schwere, Dauer/ Stadium, Komorbidität, Delinquenz, Desintegration etc.), – der Diagnostik sowie den Indikations- und Allokationsentscheidungen in der Versorgungsrealität sowie – den eingesetzten Interventionsmethoden (Substitutionsmittel, Therapie komorbider Störungen, psychotherapeutische und soziale Interventionen) • Die Ermittlung von Problemen der Substitutionstherapie bei verschiedenen Risikogruppen (z.B. Hepatitis-C- und HIVPatienten) • Die Beschreibung des Kurzzeitverlaufs und Outcomes hinsichtlich verschiedener klinischer und sozialer Kriterien Methodik: Die Studie teilt sich in einen deskriptiv-klinisch-epidemiologischen und einen analytisch-evaluativen Teil. Der deskriptive Teil soll zunächst darüber Auskunft geben, wie viele und welche Arten von Substitutionseinrichtungen in Deutschland wie viele Opiatabhängige erreichen und behandeln. Auf dieser Grundlage soll dann im evaluativen Teil an möglichst repräsentativen Einrichtungen und Patienten beurteilt werden, wie und mit welchen Methoden welche Arten von Patienten und Problemlagen versorgt werden. Durch Abgleich mit den wissenschaftlichen Bewertungsmaßstäben können daraus Defizite, Probleme und mögliche verbesserte Allokationsstrategien abgeleitet werden. Ergebnisse: Es werden erste Vorstudienbefunde und Ihre Design- Konsequenzen vorgestellt und diskutiert. / In the present paper, we will describe aims, methods, and design along with selected pre-study findings of an epidemiological study in a nationally representative sample of substitution doctors (N = 381) and their patients (n = 2500) in Germany. The project has three major components: (a) Pre-study: We sent mailed questionnaires to a sample of over 1000 substitution doctors to describe qualification and setting characteristics, treatment profiles and attitudes of substitution doctors in Germany. (b) Cross-sectional study: With a two-step epidemiological design (target day assessment of the patients, clinical appraisals by the doctors), our main aims were (1) to determine the number of opiate addicts treated by methadone or buprenorphine or other substitution drugs; (2) to find predictors and correlates for treatment, taking into account doctors, patients, and system variables; and (3) to evaluate cross-sectional differences between groups with regard to clinical presentation (comorbidity), clinical course, acceptance/compliance, critical incidences, and social integration. (c) Furthermore, the study includes a prospective-longitudinal cohort study of a total of 1000 patients sampled from this data base. The cohort will be followed-up over a period of three months to investigate whether buprenorphine patients have a more favorable course and outcome in terms of clinical, psychosocial, pharmaco-economic, and related measures. Selected pre-study findings are summarized, highlightening that current registers include a considerable proportion of doctors and a considerable heterogeneity of setting characteristics in terms of the number of patients, choice of substitution drugs and involvement in hepatitis- C treatment.

Studiens syfte är att undersöka hur behandlingspersonal vid en opiatmottagning i en stor stad i Sverige ser på substitutionsbehandling och vilken betydelse behandlingsformen har för klientgruppen. Studien baseras på fyra kvalitativa semistrukturerade intervjuer med personal som har olika professioner (kurator, sjuksköterska, läkare samt psykolog) vid en för studien relevant behandlingsenhet. För att analysera det inkomna materialet har följande fem teorier använts: biologiska teorier, systemteorier, stämplingsteori, behavioristiska teorier samt psykodynamiska teorier/anknytningsteori. Resultaten visar att personalen överlag har en liknande syn på bakgrunden till ett drogmissbruk då samtliga anser att orsaken beror på både genetiska och sociala faktorer. Personalen anser även att behandlingsenhetens klienter är i behov av kemiskt framställda opiater (buprenorfin eller metadon) för att kunna bryta med sitt drogmissbruk, detta då det bidrar till att klienterna kan börja fokusera på andra livsområden utöver droganvändandet. Vidare visar resultaten att personalen anser att behandlingens längd varierar från individ till individ. Gruppen opiatberoende anses vara en resurskrävande grupp och önskemål finns gällande bättre samarbete med – för klienten – relevanta myndigheter. Sammanfattningsvis anser personalen att klienterna – genom behandlingen – får hjälp att uppnå ett drogfritt liv, bli en del av samhället, känna sig tillfreds med sig själva; genom detta får klienterna ett bättre och mer stabilt liv. / The purpose of this study is to examine how personnel working at a opiate substitution treatment clinic in a large city in Sweden view the treatment method and how important they reckon that the treatment is for the clientele. The study is based on four qualitative semi-structured interviews with a professional team that consists of counsellor, nurse, doctor and psychologist. To analyze the data the following five theories have been used: biological theories, system theories, labeling theory, behavioristic theories and psychodynamic theories/attachment theory. The results show that the professional team generally have a similar view on the background variables of drug addiction as they generally believe it depends on genetic and social factors. The main consensus of the team is that the clients are in need of chemically manufactured opiates (buprenorphine or methadone) to end their drug addiction because it helps the clients to focus on other areas, besides drugs, in their lives. The results also show that the team believe that the length of the treatment varies from individual to individual. Opiate addicts are considered to be a resource-demanding group and the team would like a better co-operation with relevant authorities. In conclusion the personnel believe that the clients – with help from the treatment method – can reach a life without drugs, become a part of the society and feel satisfied with themselves; with this the clients get a better and more stabile life.

Using thematic analysis, this qualitative study investigates desistance from illicit drug use from the perspective of patients within opioid substitution treatment (OST). Wikström's theoretical framework was used to explain this process. From semi-structured reflective interviews with 12 patients admitted to an OST clinic in Sundsvall, three main themes were identified as relevant to the research aim. These main themes were labelled as follows: Motives for desistance, Perspectives on OST and Recipe for successful desistance. The findings were similar to those of previous research. The participants expressed criticism on specific regulations within OST, but were positive to the treatment in general. They felt a lack of emotional support from OST, but still reported an improvement in mental well being. While varied views on diversion of OST medication were expressed, a majority believe dillicitly used opioids to originate from sources other than OST. In conclusion, the participants viewed OST as an essential method for desistance from illicit drug use. Having a sincere will to desist and perceiving the past illicit opioid use as problematic were also deemed necessary for the treatment to be successful. / <p>2017-06-01</p>

Charles University in Prague First Faculty of Medicine Study programme: Specialization in Health Care Branch of Study: Addictology PharmDr. Bc. Zbyněk Oktábec, Ph.D. et Ph.D. Design of Pilot Clinical Trial of Treatment of Hepatitis C in Polyvalent Problem Drug Users with Pharmacological Substitution of Opioids and Methamphetamine (HCV-PPDUSOM) Master's Thesis Advisor: Mgr. Roman Gabrhelík, Ph.D. Prague, 2016 Abstract Hepatitis C is one of the most serious blood-borne complications of somatic health status of drug users. The HCV-positive injecting drug users are therefore directly indicated for the treatment of this type (and other types also) of hepatitis. Problematic adherence and treatment compliance is obvious in this group. Both foreign and domestic experiences show that stabilization of the use of illegal (and/or illegally acquired) substances is the essential part of the treatment of hepatitis. The interaction of the high quality treatment of somatic, psychosocial and add-on pharmacological care, including the substitution of illegal (and/or illegally acquired) drugs, leads to patient's increased compliance and adherence to HCV treatment. This diploma thesis is presenting both the theoretical frame and the study design of the pilot clinical trial of HCV treatment with the supportive substitution...

BACKGROUND: Despite the high number of methamphetamine users in the Czech Republic, the treatment is still only abstinent. Pharmacotherapy in terms of substitution treatment is not yet in place. No study has yet been conducted to examine the views of workers working with methamphetamine users on the possibility of introducing substitution treatment for methamphetamine dependence in the Czech Republic. OBJECTIVE: The aim of the practical part was to map the opinions of outpatient staff on the possibility of introducing substitution treatment for methamphetamine dependence. The monitored area included the evaluation of the success of the treatment of methamphetamine dependence in outpatient settings, disparity in working with users by substance use, percentage of methamphetamine users in the facilities, the suitability of drug addiction to methamphetamine for clients of outpatient facilities and position of substitution treatment for methamphetamine, according to respondents. METHOD: The sample was elected on the basis of deliberate targeted selection through the institutions. Data capture was performed using a semi-structured interview method, which was recorded using audio recording and then transcribed. The data capture method was used to analyze the data. FILES: The research team consisted of...

Background: In Kazakhstan, opioid substitution therapy (OST) has been a controversial topic since its introduction in 2008. Aim: To examine and analyse factors influencing approach towards OST among OST patients, opioid-dependent drug users who could re-consider engagement in this therapeutic method, as well as attitudes of selected key organisations and their representatives. Methods: A survey method complemented by semi-structured individual and group interviews has been selected. One hundred respondents participated in the study between October and December 2015. The first group consisted of 46 OST patients. The second group consisted of 54 respondents who met criteria for opioid dependence. This group included patients of residential treatment centres, former OST patients and current injecting drug users. Key persons were interviewed about their attitudes. Results: Patients receiving OST, with the average treatment duration of 29.4 months, reported improved health, improved social functioning and financial well-being, as well as reduction of their involvement in crime. This group showed better results in all examined categories. Most (80 %) were satisfied with the treatment, even though a number of shortcomings have been reported. All OST patients considered necessary to expand the availability...

Hintergrund: Die Datenlage zur Substitutionstherapie Opiatabhängiger ist defizitär. Vor diesem markant defizitären Erkenntnishintergrund erscheint es sinnvoll und notwendig, eine versorgungsepidemiologische Studie zur aktuellen Versorgungslage opiatabhängiger Substitutionspatienten durchzuführen, um offene Fragen zu klären. Hierfür haben wir ein mehrstufiges Forschungsprojekt unter dem Akronym COBRA initiiert. COBRA steht für "Cost-Benefit and Risk Appraisal of Substitution Treatments" und signalisiert, dass wir uns in umfassender Weise um eine Evaluation der Risiken, Vor- und Nachteile verschiedener Interventionsstrategien und Modalitäten in der Substitutions- und Versorgungspraxis Opiatabhängiger in Deutschland bemühen. Zielsetzungen des COBRA-Projekts sind: • Die Charakterisierung von bestehenden Einrichtungsformen und -modellen; • Die Charakterisierung von: – Merkmalen opiatabhängiger Patienten in diesen Einrichtungen (Schwere, Dauer/ Stadium, Komorbidität, Delinquenz, Desintegration etc.), – der Diagnostik sowie den Indikations- und Allokationsentscheidungen in der Versorgungsrealität sowie – den eingesetzten Interventionsmethoden (Substitutionsmittel, Therapie komorbider Störungen, psychotherapeutische und soziale Interventionen) • Die Ermittlung von Problemen der Substitutionstherapie bei verschiedenen Risikogruppen (z.B. Hepatitis-C- und HIVPatienten) • Die Beschreibung des Kurzzeitverlaufs und Outcomes hinsichtlich verschiedener klinischer und sozialer Kriterien Methodik: Die Studie teilt sich in einen deskriptiv-klinisch-epidemiologischen und einen analytisch-evaluativen Teil. Der deskriptive Teil soll zunächst darüber Auskunft geben, wie viele und welche Arten von Substitutionseinrichtungen in Deutschland wie viele Opiatabhängige erreichen und behandeln. Auf dieser Grundlage soll dann im evaluativen Teil an möglichst repräsentativen Einrichtungen und Patienten beurteilt werden, wie und mit welchen Methoden welche Arten von Patienten und Problemlagen versorgt werden. Durch Abgleich mit den wissenschaftlichen Bewertungsmaßstäben können daraus Defizite, Probleme und mögliche verbesserte Allokationsstrategien abgeleitet werden. Ergebnisse: Es werden erste Vorstudienbefunde und Ihre Design- Konsequenzen vorgestellt und diskutiert. / In the present paper, we will describe aims, methods, and design along with selected pre-study findings of an epidemiological study in a nationally representative sample of substitution doctors (N = 381) and their patients (n = 2500) in Germany. The project has three major components: (a) Pre-study: We sent mailed questionnaires to a sample of over 1000 substitution doctors to describe qualification and setting characteristics, treatment profiles and attitudes of substitution doctors in Germany. (b) Cross-sectional study: With a two-step epidemiological design (target day assessment of the patients, clinical appraisals by the doctors), our main aims were (1) to determine the number of opiate addicts treated by methadone or buprenorphine or other substitution drugs; (2) to find predictors and correlates for treatment, taking into account doctors, patients, and system variables; and (3) to evaluate cross-sectional differences between groups with regard to clinical presentation (comorbidity), clinical course, acceptance/compliance, critical incidences, and social integration. (c) Furthermore, the study includes a prospective-longitudinal cohort study of a total of 1000 patients sampled from this data base. The cohort will be followed-up over a period of three months to investigate whether buprenorphine patients have a more favorable course and outcome in terms of clinical, psychosocial, pharmaco-economic, and related measures. Selected pre-study findings are summarized, highlightening that current registers include a considerable proportion of doctors and a considerable heterogeneity of setting characteristics in terms of the number of patients, choice of substitution drugs and involvement in hepatitis- C treatment.

Background: Substitution treatment has become a stable part of the addiction services system for drug users. In the beginning, it primarily reacted to healthcare complications related to intravenous substance use and was an alternative for those not able to keep an abstinence. It is proved that only pharmacotherapy is not enough intervention and that it is key to add counseling or therapy as it becomes similarly effective as abstinence-oriented treatment where we work on lifestyle changes in clients. Objective: Identification of effective factors leading to an increase in quality of life from the perspective of clients in substitution treatment in CADAS SANANIM z.ú. Methods: A semi-structured interview and a standardized WHOQOL-BREF questionnaire of the World Health Organization were used to obtain the required data. The descriptive method of thematic (focal) analysis was used to process data from the interviews, and data from the questionnaire was evaluated according to the instructions of the User's Guide of the Czech version of the WHO quality of life. Sample: The research participants consisted of 11 clients of the substitution program in CADAS SANANIM z.ú., who have been in treatment for at least 5 years and are included in the stabilization phase category. I contacted 15 clients, which I...

Background Heroin dependence is associated with increased risk of the transmission of blood-borne viral (BBV) infections such as HIV, as a result of unsafe injecting practices. Opioid Substitution Treatment (OST) Programmes including Methadone Maintenance Treatment (MMT) programmes are a recommended way of addressing heroin dependence with the dual aims of reducing both heroin use and associated harms. However, OST programmes, particularly in prison settings, are often unavailable, in spite of large numbers of prisoners with heroin dependence and the high risk of HIV transmission in the prison setting. Little is currently known about the delivery of OST programmes within prison settings. A systematic literature review conducted within this study revealed that there are only a small number of studies from middle and lower-income countries and the perspectives of the range of stakeholders are often underrepresented. Aim and setting of this study This aim of this study was to understand the role of Methadone Maintenance Treatment (MMT) programmes within the context of HIV prevention programmes and to identify barriers and facilitators that influence the implementation, routine delivery and sustainability of methadone programmes in Indonesian prisons. Study design Three prison settings were selected as part of a qualitative case study. These comprised: a narcotics prison that provided methadone, a general prison that provided methadone, and a general prison, where there was no methadone programme. This allowed the exploration of multiple perspectives of prisoners and the diverse range of staff involved in the implementation of programmes. Interview and observational data were supplemented by data from medical case notes. Qualitative data underwent thematic analysis, with the help of framework analysis for data management. Principal findings This study found that there were many misconceptions about methadone programmes. HIV infection was not recognised as a problem and prison staff, healthcare staff and prisoners alike lacked understanding of the roles of methadone programmes. Prisoners participating in programmes were often stigmatised, while many prisoners believed methadone withdrawal was dangerous and could lead to death. These factors all contributed to low level participation, observed in both prisons with methadone programmes. Lack of confidentiality and associated stigmatisation as well as inappropriate assessment criteria also contributed to this, as did a lack of support systems. A reduction in international funding and a shift in national drug policy priorities away from the provision of methadone to drug-free Therapeutic Community (TC) programmes, together with a failure to embed methadone programmes within the daily prison routine currently pose challenges to effective implementation, delivery and programme sustainability. Conclusion Educating policy makers and practitioners could improve understanding of the roles of methadone programmes and increase support for programme delivery within prisons. It is therefore recommended that Indonesian government and prison policy focuses on ensuring effective delivery and sustainability of methadone programmes for people with heroin dependence in the prison setting.