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Opioid Agonist Treatments for Opioid Use Disorders: A Rapid Qualitative Review

Last updated: April 30, 2019
Project Number: RC1100-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. How do people with opioid use disorders, and their health care providers, understand, communicate, and make decisions related to opioid agonist treatments?
  2. How have people with opioid use disorders experienced treatment with opioid agonists? What are their perspectives on and preferences for programs that offer opioid agonist treatments?
  3. How have health care providers who care for people with opioid use disorders experienced supporting opioid agonist treatment? What are their perspectives on and preferences for programs that offer opioid agonist treatments?

Key Message

The use of opioids is a complex experience that some people viewed as a major component of their identity. Because of their addiction, the lives of patients with OUD were often seen to revolve around behaviours and activities associated with drug use. As such, approaches and treatments that aim to support patients towards recovery-oriented behaviours require a detailed consideration of how drug use and behaviour influence patients’ motivation, circumstances, beliefs, and life plans. For patients, a range of challenges, opportunities, and barriers are identified. At the onset of treatment-seeking behavior, patients are faced with challenges due to a lack of internal motivation. Even patients who were able to achieve motivation to seek and initiate treatment continue to face further challenges depending how treatment programs are structured and implemented. For example, access may be limited due to geographical distance or administrative procedures or criteria. Barriers permeated throughout patients’ described experiences in continuing treatment-seeking behaviour, which provided opportunity for patients to reflect on aspects of treatment programs that may facilitate ongoing participation. For example, many patients identified the advantages of a program that offered higher flexibility and autonomy, and greater opportunities to lead a normal lifestyle. Some patients, however, found aspects of rigid programs to be more useful, especially in the beginning when they were establishing a routine towards recovery. Patients also contrasted buprenorphine (and its variants such as suboxone) and methadone when describing their experiences with opioid agonist treatments. Overall, patients expressed a more positive view of buprenorphine due to lesser experienced side effects and its perceived ability to restore normalcy into their everyday living and reduce withdrawal symptoms. Patients also described more positive experiences with buprenorphine being offered through office-based programs, which seemed to be related to less stigmatizing experiences, which they associated with methadone clinics in particular. Importantly, patients described the importance of a comfortable clinical space in which to receive treatment, which included providers who exemplified unconditional positive regard and an openness to communication.Health care providers similarly expressed a variety of concerns and preferences with regards to providing opioid agonist treatments for patients with opioid use disorders. Multiple studies identified initial hesitations to engage in or offer opioid agonist treatments, which often appeared to stem from a lack of time amongst other competing clinical priorities and also a lack of knowledge, training, and awareness. These hesitations were also typically related to the holding of negative attitudes and beliefs towards the opioid use disorder patient population: that these patients are aggressive, challenging, and create a negative perception of their practice. Suggestions to alleviate these barriers include improving collaboration, coordination, infrastructure, and support for opioid agonist treatments in primary care. Moreover, initial hesitations and stigmatized beliefs were thought to be addressed through training that creates opportunities and space for health care providers to interact with the patient population and see firsthand the benefits to providing opioid agonist treatments.