Opioid maintenance treatment and social aspects of quality of life for first-time enrolled patients. A quantitative study. : A quantitative study.

Abstract

Opioid dependence is a chronic lifelong disease, and opioid maintenance treatment is a well-documented effective treatment for this disease. A vast research exists on opioid maintenance treatment; however, research has primarily investigated socially desirable outcome goals such as reduced overdose deaths, criminality and drug use. The focus on other outcomes has been inadequate. This thesis contains three papers that are based on patients’ own reported outcomes; they examine patients’ natural treatment progression and changes in their life course with a specific focus on social factors and quality of life. In Paper I, we described the patients’ sociodemographic characteristics at first admission to opioid maintenance treatment and investigated how being exposed to potential adverse experiences could be associated with their age at opioid onset. The results indicated that the participants were heterogeneous; they differed in their sociodemographic characteristics, age at opioid onset, and exposure to potentially adverse events in life. We did find a strong association between age at opioid onset use and being in care, family members that had been in prison or that were currently in prison, and school dropouts. Based on the total number of adverse experiences, 59% of all participants had a medium risk exposure in their childhood and adolescent. Paper II examined patients’ overall quality of life during the first year after enrolment in opioid maintenance treatment. In addition, we investigated potential correlations with overall quality of life to domain-specific quality of life indicators such as housing, relationship with children and friends, work, leisure, health and financial situation. According to the results, patients differed in their level of quality of live at baseline as well as in their change across time. However, the overall quality of life increased significantly during the first 12 months. There was a positive rate of change for all specific quality of life domains, but the financial domain was the only domain that achieved statistical significance. Overall quality of life regressed on domain-specific quality of life, indicating that housing, leisure and financial situation were positively associated with a higher overall quality of life. In Paper III, we focused on the effects that opioid maintenance treatment had on substance/polydrug use and whether social factors were associated with substance/polydrug use during the first 12 months. Polydrug use consisted usually of substances such as benzodiazepines, cannabis, amphetamine and alcohol. We did not find an effect of time on polydrug use. However, a relationship between time and use of opioids was found, indicating a significant reduction in opioid use during the first 12 months. Age of substance use onset was associated with polydrug use, indicating that the older the age at onset, the lower the polydrug use in opioid maintenance treatment. Furthermore, opioid use was associated with overall quality of life, but we did not find any domain-specific quality of life-indicators for polydrug or opioid use. Polydrug use/opioid use was not associated with domain-specific quality of life-indicators. In addition, we did not find any Time by Total adverse experiences interaction, Time by Total resources interaction, or Time by Age of substance use onset interaction. In summary, the thesis’ results suggest that participants have different sociodemographic characteristics, come from diverse social strata and bring various life experiences and traumas into treatment. By addressing this heterogeneity as new patients are enrolled in OMT, clinicians may induce a more individually adapted treatment for patients in OMT. Besides, participants vary in overall quality of life, yet their overall quality of life improves during the first 12 months in opioid maintenance treatment. The fact that patients perceive enhanced quality of life may highlight the importance of emphasizing the psychosocial aspects that are important to patients in OMT.