Service user involvement in methadone maintenance programmes: The ‘philosophy,the ideal and the reality’

Internationally, service user involvement has become a common feature of public policy and more specifically public health policy in the recent decades. In a general context, the involvement of service users in health services has been well documented; however, less evidence is available within the area of drug treatment service provision. This study, which was conducted in Ireland, sought to address this gap in the knowledge and understanding of service user involvement within this setting. Qualitative in-depth interviews were undertaken with a broad range of participants. The sample, which totalled 20 individuals, comprised both service users and service providers. Meanings, and mechanisms of and limits to user involvement were explored. This study highlights the ambiguity that exists between policy recommendations on service user involvement and actual practice within treatment services. Although, participants acknowledged that services could and should learn from the individual and collective experiences of service users, they were found to be passive players in planning, developing, evaluating and delivering the services they received. The study suggests that in order to change the rhetoric of policy recommendations into a reality within this context, a much more committed approach which includes the education and training of all involved in drug treatment services is required.     

Retention in methadone maintenance treatment in mainland China, 2004–2012: A literature review

Background

Methadone maintenance treatment (MMT) was implemented in mainland China since 2004. Numerous individual studies have investigated MMT retention but the overview still remains unclear. The aim of the study was to review MMT retention rates and predicting factors in mainland China during 2004–2012.

Methods

Chinese and English databases of literature were searched for studies reporting on retention rates and predicting factors in non-transfer MMT patients of fixed-site clinics in mainland China (2004–2012). Qualitative methods were used to synthesize the results.

Results

Nineteen studies were eligible for review, with sample size ranging from 29 to 3758. Retention rates varied between 30.0% at 6 months in Shanghai and 70.3% at 12 months in Xi'an. Predicting factors were non-treatment including sociodemographics (n = 14), support system and social function (n = 9), economic status (n = 2) and psychological status (n = 1), and treatment-related including drug use (n = 15), methadone use (n = 12), MMT clinics (n = 9), MMT participation (n = 7), awareness on MMT (n = 5) and HIV serostatus (n = 3). Methadone dose (n = 12) and age (n = 7) were the first two important specific factors.

Conclusions

In mainland China, MMT retention rates are heterogeneous and relatively lower, and predicting factors mainly focus on objective aspects. Future work should further explore subjective predicting factors regarding MMT retention.     

Trends and predictors in methadone maintenance treatment dropout in Shanghai,China: 2005–2011

Abstract

Background:

The methadone maintenance treatment (MMT) program has been implemented in Shanghai since 2005. This study aims to portray the trend of MMT dropout and identify predictive factors that may influence dropout in Shanghai MMT clinics, which could assist in the intervention strategy development.     

Service providers’ perceptions of barriers to the implementation of trauma-focused substance use services for women in Cape Town,South Africa

BackgroundA substantial number of South African women with substance use disorders also report psychological trauma related to experiences of physical and sexual abuse. Trauma-focused substance use programmes may support recovery from co-occurring substance use disorders and psychological trauma, yet integrated programmes are not widely available in South Africa. As part of the process of developing a trauma-focused substance use programme for South African women, we explored service providers’ views of the feasibility of implementing trauma-focused substance use interventions within usual care settings in Cape Town, including potential barriers that need to be considered when planning for implementation.MethodsWe conducted 16 in-depth interviews with key informants responsible for planning or delivering substance use, psychological trauma or gender-based violence services to women in Cape Town. Guided by Extended Normalisation Process Theory, interviews explored participants’ perceptions of the potential value of trauma-focused substance use programmes, the feasibility of their implementation, and factors that may facilitate or hinder the implementation of trauma-focused substance use programmes. Qualitative data were analysed using the framework approach.ResultsThree themes emerged: (1) Potential for the implementation of trauma-focused substance use programmes, describing participants’ views of the acceptability of these programmes; (2) Capacity for intersectoral collaboration, which participants considered necessary for limiting barriers to implementation; and (3) Co-operation with community structures to enhance capability for implementation.ConclusionFindings show potential for implementing trauma-focused substance use interventions in South Africa, however context-specific capacity and capability barriers need to be considered and addressed for implementation to be successful.     

Active heroin injectors' perceptions and use of methadone maintenance treatment: cynical performance or self-prescribed risk reduction?

In addition to the numerous heroin users who voluntarily enter methadone treatment as a way to free themselves from illicit drug addiction and those ordered to do so by the courts, there are a large number of opioid users who enter methadone treatment with other objectives in mind. These include shorter-term goals that users do not necessarily equate with complete heroin abstinence. In this paper we report the results of a qualitative study designed to identify and describe the motivations active heroin users have for entering methadone treatment, and to suggest that many of these short-term methadone episodes may operate as self-prescribed attempts at risk reduction, and act as pilot tests for users considering or anticipating entering treatment to quit the use of illicit drugs. We argue that heroin users' motivations, perceptions about methadone, and the strategies they devise for adapting methadone treatment for their own needs should be recognized for their value in reducing the multiple risks associated with drug use.     

An exploration of prisoners’ and prison staff 's perceptions of the methadone maintenance programme in Mountjoy Male Prison,Dublin, Republic of Ireland

This study, which was based in Ireland's main committal prison, used semi-structured interviews and a focus group to explore the perceptions of staff and prisoners towards methadone maintenance within the prison setting. Although the research subjects identified advantages and disadvantages associated with methadone prescribing within the prison, they were generally positive in their assessment of Mountjoy's methadone programme. Prisoners perceived it as leading to an improvement in their relationships with their families, while staff viewed it as facilitating a more stable and safer working environment. However, although prisoners’ use of heroin had reportedly declined since the advent of the methadone maintenance programme in the prison, their use of other drugs had not. There were negative views expressed by both groups about the manner in which methadone is dispensed within the prison, and also because methadone was viewed as being as addictive as heroin. Regarding perceptions of the purpose of methadone maintenance, there was a spectrum of interpretations among the interviewees. Five purposes were identified. These were: (1) to ensure continuity of harm-reduction policies from the community; (2) to reduce the supply of heroin in the prison; (3) to prevent needle sharing and the spread of blood-borne infections; (4) to treat heroin addiction; and (5) to control prisoners and maintain order and discipline within the prison. Apropos the latter, there was a widely held perception within the total sample that this latent function of methadone maintenance could be seen as of greater importance than the more conventional harm-reduction functions that were also identified.     

Pathways to ‘recovery’ and social reintegration: The experiences of long-term clients of methadone maintenance treatment in an Irish drug treatment setting

IntroductionThis paper examines the experiences of long-term clients of methadone maintenance treatment (MMT) in one area of Dublin in the context of a recent emphasis on rehabilitation and recovery in Irish drug policy.MethodsIn-depth qualitative interviews were conducted with 25 long-term clients of methadone maintenance treatment (MMT). All participants had first enrolled in methadone treatment at least ten years prior to participating in the research and a majority (n = 16) had first accessed MMT more than 20 years previously.ResultsWhile acknowledging several beneficial aspects of methadone treatment, research participants saw themselves as passive recipients of a clinical regime that offered no opportunity to exercise agency in relation to their ongoing treatment. Rather than perceiving themselves as progressing along a pathway to recovery, the treatment experience was depicted in terms of stasis or confinement. Neither did participants report any progress in attaining the kind of social reintegration that is commonly presented as a key aspect of addiction recovery and which, in the Irish context, is a central plank of drug policy discourse.DiscussionThe findings highlight a disconnect between policies that ostensibly aim to promote social reintegration and recovery and the experiences of individuals who are long-term clients of MMT. Irish policy aspirations of facilitating opiate-dependent clients to progress along a pathway to recovery are difficult, if not impossible, to realise given the marginal status of addiction services within the health system and the difficulties involved in securing ongoing cooperation from other public service sectors.     

Safety and efficacy of maintenance infliximab therapy for moderate-to-severe Crohn’s disease in children: REACH open-label extension

Abstract

Objective:

Assess long-term effects of maintenance infliximab therapy in children with moderately-to-severely active Crohn’s disease.     

Patients’ perceptions of pharmacist-managed diabetes services in the ambulatory care and community settings within Singapore

Background Qualitative evidence on patients’ perceptions of pharmacist-managed diabetes services (PMDSs) is limited. Objective To explore patients’ perceptions of PMDSs Setting Patients being cared for in the outpatient settings in Singapore. Methods This focus group included patients who were diagnosed with type 2 diabetes, spoke either English or Mandarin, attended PMDSs for at least 6 months in the ambulatory care or community settings, and were at least 21 years of age. Patients with cognitive impairments or mobility issues were excluded. Thematic analysis of transcribed audio recordings was undertaken. Main outcomes measure Patients’ care experiences with PMDSs. Results A total of 26 patients from two outpatient ambulatory care clinics and three retail pharmacies were assembled into four focus groups based on the care setting. Four themes abstracted from focus group data illustrated patients’ perspectives on PMDSs in fulfilling their health needs, delivery and quality of service, changes attributed to the service, and suggestions for improvement of service. The patients highlighted that PMDSs fulfilled their need for information on diabetes. They also felt comfortable speaking to the pharmacists about their health, and they appreciated the role of the pharmacists as healthcare professionals. Furthermore, the patients reported better diabetes-related self-empowerment via increased medication knowledge and lifestyle modification. Some of the patients noted that medication adherence and glycemic control had improved. Suggestions to improve PMDSs were minimal. Conclusions Overall, patients with type 2 diabetes had positive perceptions of PMDSs regardless of the care settings.     

Trends in methadone maintenance treatment participation,retention, and compliance to dosing guidelines in British Columbia,Canada: 1996–2006

Aspects of methadone maintenance treatment (MMT) delivery, particularly daily dosing practices, are associated with longer retention in treatment. Our objective was to identify trends in compliance to MMT dosing guidelines at the population level in British Columbia, Canada, from 1996 to 2006. Analysis of a provincial drug dispensation database identified 31,724 MMT episodes initiated during the study period. The number of patients in treatment increased from 2,827 in 1996 to 9,601 in 2006. Long-term retention (>36 months) was achieved in 20%–25% of all episodes. Compliance to minimally effective dose guidelines, which is independently associated with retention, fell from 2001 to 2006. Accordingly, this decline was mirrored by 12-month retention figures, which fell from 45.9% in 2001 to 40.5% in 2005. Our evaluation has both highlighted the successes of the British Columbia Methadone program and identified aspects that may be improved to ensure safety and maximize the benefits of MMT.     

“Each one has their own role”: Exploratory study on consumers’ perceptions about nutritionists services provided in community pharmacies

Obesity and overweight have grown to epidemic proportions in the past decades. To tackle this rising threat to health systems, lifestyle changes and nutritional education have been promoted through specialized programs and nutritional primary health care services. Community pharmacies adjustment to a new paradigm of pharmacy services means that they are not just a place for buying and selling medicines, but increasingly a space for diverse health care services. One such service addresses the weight problems of community pharmacy users through the provision of nutrition consultation services. In Portugal, these consultations are provided by nutritionists, many times under formal agreements with nutritional supplements commercial brands. Methods: The aim of this exploratory study was to characterize the experience of people attending nutrition consultations at two different pharmacies and to understand their perception of the role community pharmacists may have in weight management. To conduct this study, interviews were performed following an interview guide comprised of sociodemographic characterization questions and open-answer questions. Results: Ten people participated in the study, seven females and three males. The average self-reported BMI of the sample was 29.4Kg/m2. The results showed that there is a general satisfaction with nutrition consultations, with all respondents agreeing that community pharmacies are a right place to have these consultations. Accessibility and low cost were found to be the biggest advantages in having nutrition consultations at a pharmacy. On the other hand, these participants felt that the biggest disadvantage was the price of nutritional supplements. Lack of motivation was also seen as a major impediment to continue with the nutrition consultations. When participants were asked about what role community pharmacists may have in weight management, 50% of participants disagreed with the idea of pharmacists providing the service on their own. Conclusion: the results of this study indicate that the degree of satisfaction of those attending the nutrition consultations is high, especially because of pharmacies’ accessibility and proximity, hinting at the idea of efficiency as an important factor driving the demand for new health care services. Pharmacists were viewed as having a gatekeeper role, but the nutrition service provision should be exclusively provided by nutritionists, in an example of successful multidisciplinary practice within the community pharmacy setting. Future studies should focus on the effect these consultations have on the loss or maintenance of weight, including the comparison with service provision in the traditional settings.     

Consumers’ perceptions of community pharmacy in Portugal: a qualitative exploratory study

Objective: Pharmacists are health professionals who are ideally positioned to perform a primary health care role. However, the definition of professional value needs to be considered not just as professional education and skills, but also in terms of how consumers perceive it. The main aim of this work was to explore the public’s perceptions and attitudes towards community pharmacy in Portugal.Methods: A pure qualitative approach was undertaken. The data were collected through a semi-structured interview, conducted with a ‘snowball’ like sample. First, individuals (n = 15) were interviewed, allowing for adjustment and validation of the interview schedule, followed latter by group interviews with adults in rural and urban areas. Group participants (n = 25) were asked about their behaviour and beliefs, resulting from their perceptions of community pharmacies, pharmacists and medicines. Future expectations regarding the community pharmacy service were also explored. The interviews were tape recorded and transcribed verbatim. An iterative, reflexive coding process was applied, assisted by the qualitative software package QSR NUD*IST v4. The inductive analysis of the extracted codes assembled those codes into themes.Results and discussion: This article will mainly focuses on community pharmacy service representations and cognitions (theme A) and community pharmacy evaluative perceptions and behaviours (theme B). Participants displayed general and contradictory ideas about the actual functions of the pharmacist, including weak conceptualizations and a positive demand for services in relation to product supply. This superficial understanding is in line with previous results from satisfaction studies, confirming a low expectation level. The public’s poor knowledge and low expectations can justify a reduced desire for an extended role of the pharmacist in the community. This uncertain service conceptualization does not define the professional responsibility from a consumer’s perspective.Conclusions: Although these results allow for the development of a framework to describe the perceptions of community pharmacy users, further research is needed to determine the prevalence of these and other possible results.     

Challenges in chronic illness management: a qualitative study of Australian pharmacists’ perspectives

Objective To explore pharmacists’ views on managing patients with chronic illness; to understand the incentives and barriers they perceive and the solutions they propose to overcome these barriers. Setting Hospital pharmacists, with experience in managing people with chronic illnesses, working in western Sydney, Australia, were interviewed during June and July 2008. Method A qualitative study involving group and individual interviews using a semi-structured interview guide. Results Hospital pharmacists identified lack of communication between different healthcare providers and with patients as a contributing factor to lack of continuity of care and this was perceived as a major barrier in managing patients with chronic illnesses. Pharmacists were also concerned about the effects of medication costs, and poor patient knowledge regarding their disease and medications, and the effects on adherence. Suggested solutions included taking a teamwork approach in the management of chronic illness and providing more information to patients to improve adherence. Conclusion The identified incentives and barriers have provided valuable information on what pharmacists face in managing patients with chronic illness. Most of the solutions suggested by them have been tested and proven unsuccessful. Develop successful health policy to address the identified barriers remains a challenge.     

Autism: an emerging ‘neuroimmune disorder’ in search of therapy

Background: Autism spectrum disorders (ASDs) are neurodevelopmental disorders characterized by difficulties in communication and by repetitive and stereotypic behaviors, as well as by social impairment, attention, cognitive, and learning defects. ASDs present in early childhood and their prevalence has increased significantly to 1/150 children. Despite a number of theories, the actual reasons for this increase are still not clear. There is no reliable screening test, and no definite pathogenesis or curative therapy. Consequently, there is a major gap hampering development of effective treatments. Objective: To review recent publications on ASDs pathogenesis and treatment with emphasis on neuroimmune processes and new therapeutic approaches. Methods: Mostly original papers (450) on epidemiology, possible pathogenesis or treatment of ASDs in Medline from 1990 to May 2009 were reviewed. All authors contributed to this review. Results/conclusion: Increased oxidative stress and immune dysregulation are present in ASDs. Mast-cell activation may contribute to gut–blood–brain barrier disruption and brain inflammation. No effective treatments have emerged. Well-designed clinical trials with nonpsychotropic drugs were few and ASD characteristics varied considerably, making conclusions difficult. Psychotropic drugs are often used for stereotypic and aggressive behaviors. Unique combinations with antioxidant and anti-inflammatory flavonoids hold promise. New potential translational research areas and possible treatments are suggested.