Studiens syfte är att undersöka individens subjektiva upplevelse av att genomgå läkemedelsassisterad behandling för opioidberoende (LARO). För att besvara studiens syfte och frågeställningar har vi använt oss av kvalitativ metod i form av både fokusgruppintervju och individuella intervjuer. I fokusgruppintervjun intervjuade vi tre yrkesverksamma för att bredda våra kunskaper inom ämnet och även för hjälp till utformningen av intervjuguiden för de individuella intervjuerna. De individuella intervjuerna bestod av sex intervjupersoner, tre som har LARO-behandling i dagsläget och tre som tidigare har haft det. Materialet från fokusgrupp- och de individuella intervjuerna presenteras i empirin med hjälp av en tematisk analys. Empirin har sedan analyserats med hjälp av tidigare forskning och Goffmans teori om stigma. Studien visar att det finns flera olika aspekter som framkommer som viktiga i individens upplevelse av att ha LARO-behandling. I studien har särskilt fysiska biverkningar och känslomässig avstängdhet lyfts som en viktig aspekt. Även sidomissbruk verkar vara något studiens deltagare anser vara ett viktigt problem. Hämtningen av medicin och kontroll är också en aspekt som verkar vara en stor del av att ha LARO-behandling. En viktig aspekt är även behandlingens livräddande förmåga, men trots denna verkar dessutom en bundenhet till behandlingen upplevas som ett problem av deltagarna. Studien visar en variation i hur individen med LARO-behandling påverkas av sociala sammanhang. Å ena sidan verkar relationerna till närstående och familj i vissa fall ha fortsatt varit fungerande, eller till och med bättre. Å andra sidan beskrivs relationerna ha försämrats. Vi kan även se hos samtliga deltagare att de varit varsamma med vilka de var öppna för om sin behandling. Studien visar att i vissa fall kunde omgivningen vara förstående, i andra fall kunde omgivningen se ner på individen. Hos våra intervjudeltagare är upplevelsen av personalens bemötande i stort positiv. Studien diskuterar skillnader i åsikter gällande frågan kring huruvida man kan vara drogfri under pågående LARO-behandling. Vissa respondenter anser att man kan vara drogfri, men lyfter sidomissbruk som ett hinder. Andra respondenter anser att man inte riktigt kan klassas som drogfri ifall man erhåller substitutionsbehandling. / The purpose of the study is to examine individuals’ subjective experiences of undergoing medication-assisted treatment for opioid dependency (LARO). To address the study’s purpose and research questions we used a qualitative method, utilizing both focus group interviews and individual interviews. In the focus group interview we interviewed three professionals to broaden our knowledge of the subject and to assist in the development of the interview guide for the individual interviews. The individual interviews included six participants: three currently undergoing LARO-treatment and three who have previously undergone it. The material from the focus group and individual interviews is presented in the empirical section using thematic analysis. The empirical data were then analyzed with the help of previous research and Goffman’s theory of stigma. The study reveals several important aspects of individuals’ experiences with LARO treatment. Physical side effect and emotional numbness were highlighted as significant issues. Concurrent substance abuse also appears to be a major concern among the study’s participants. The process of medication retrieval and monitoring is another significant aspect of LARO treatment. While the treatment’s life-saving potential is acknowledged, participants also expressed a sense of dependency on the treatment as problematic. The study shows variability in how individuals undergoing LARO-treatment are affected by social contexts. On one hand, relationships with close ones and family sometimes remained functional or even improved. On the other hand, some relationships are described as deteriorated. All participants were cautious about whom they disclosed their treatment to. The study shows that the surrounding environment could be understanding in some cases. While in other cases, individuals were looked down upon. The participants’ experiences with the staff’s attitude are generally positive. The study discusses differing opinions on whether one can be considered drug-free while undergoing LARO treatment. Some respondents believe that one can be drug-free but highlight concurrent substance abuse as an obstacle. Other believe that one cannot be truly considered drug-free if receiving substitution treatment.

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...