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>

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.

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.

Studien syftar till att undersöka hur det går till att sluta använda heroin utan att byta till användning av andra opioidpreparat och utan att erhålla substitutionsbehandling med opioidpreparaten metadon eller buprenorfin. Forskningsgenomgången visar att det är möjligt att sluta med heroin utan substitutionsbehandling, men att det är svårt att leda i bevis att vissa specifika behandlingsmetoder skapar detta resultat. Det empiriska materialet består av djupintervjuer med tio personer som delar erfarenheten av att ha varit heroinberoende och av att ha slutat använda heroin utan att erhålla substitutionsbehandling. Som teoretisk utgångspunkt används en syntes av flera sociologiska och socialpsykologiska teorier och analysbegrepp som syftar till att förklara relationen mellan mänskliga betenden och de sociala sammanhang som människan ingår i och relaterar till. Studien visar att en framgångsrik återhämtning från heroinberoende innebär en sekundär socialisering in i sociala gemenskaper organiserade kring andra företeelser än heroinanvändning, vilket möjliggör för den före detta heroinanvändaren att avhålla sig från heroin- och annan opioidanvändning. Studien visar även att en viktig komponent i återhämtningen är att, framförallt under den första tiden i återhämtningsprocessen, utveckla ett överväldigande engagemang i någon typ av sysselsättning, samt att personer som under tiden de använde heroin saknade ett överbryggande socialt kapital, har möjlighet att skapa ett sådant efter att de slutat använda heroin. / The study aims to investigate how to stop using heroin without replacing heroin with use of other opioid preparations and without receiving substitution treatment with the opioid preparations methadone or buprenorphine. The research review shows that it is possible to quit heroin addiction without substitution treatment, but it is difficult to prove that certain specific treatment methods create this result. The empirical material consists of in-depth interviews with ten people who share the experience of being addicted to heroin and having stopped using heroin without receiving substitution therapy. As a theoretical point of view, a synthesis of several sociological and social psychological theories and concepts of analysis is used to explain the relationship between human behavior and the social context in which human beings belong and relate. The study shows that a successful recovery from heroin addiction involves secondary socialization into social communities organized around phenomenas other than heroin use, which enables the former heroin user to refrain from heroin and other opioid use. The study also shows that an important component of the recovery process is, especially during the first phase of the recovery process, developing an overwhelming involvement to some type of pursuit, and that people who when they used heroin lacked any sort of bridging social capital, are able to create such after they stopped using heroin.

Bakgrund: LARO i Sverige är omgärdat av strikta regler. Läkemedlen som används, däribland buprenorfin, intas dagligen övervakat av sjuksköterska de tre första månaderna och vidare till dess att patienten bedöms kunna ta läkemedlet på egen hand. Sedan 2018 finns buprenorfin som depotinjektion veckovis eller månadsvis, vilket innebär en ny omvårdnadssituation. Syfte: Att utforska sjuksköterskans perspektiv på införandet av buprenorfin som depotinjektion i LARO. Metod: Tolv semistrukturerade intervjuer av sjuksköterskor med erfarenhet av depotinjektioner buprenorfin i LARO. Resultat: Införandet av depotinjektioner innebar ett fokusskifte i behandling och omvårdnad med bland annat minskad kontroll och ökad tillit mellan sjuksköterska och patient. Behandlingen med depotinjektioner ansågs kunna öppna för ökad egenmakt för patienterna. LARO-enheternas organisatoriska förutsättningar påverkade hur de tagit sig an den nya behandlingsformen. Kunskap och samsyn efterfrågades. Slutsats: Depotinjektioner buprenorfin kan öppna upp för nya sätt att främja egenmakt i LARO. Det finns ett behov av forskning på området. / Background: Opioid substitution treatment in Sweden is strictly regulated. Medications like Buprenorphine are taken daily supervised by a nurse during the initial three months and thereafter until the patient is assessed to be trusted with self-administration. Prolonged-release injectable Buprenorphine has beenavailable since 2018 for weekly or monthly use. This has implications for nursing care and practices. Purpose: To explore the nurse’s perspective on introducing prolonged-release injectable buprenorphine in opioid substitution treatment. Method: Twelve semi-structured interviews were conducted with nurses experienced in treatment with prolonged-release injectable buprenorphine. Results: The introduction of injection treatment entailed a shift in focus regarding restrains, trust and patient empowerment. The care units’ approaches to the new treatment differed and was influenced by organisational conditions. Nurses requested more knowledge and consensus about the new treatment. Conclusion:Prolonged-release injectable formulations may enable new approaches to patientempowerment in opioid substitution treatment. Research in this field is required.