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Addiction
Original research
Are patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder
  1. Tea Rosic1,2,
  2. Leen Naji2,3,
  3. Balpreet Panesar4,
  4. Darren B Chai5,
  5. Nitika Sanger6,
  6. Brittany B Dennis7,
  7. David C Marsh8,9,10,11,
  8. Launette Rieb12,
  9. Andrew Worster2,7,
  10. Lehana Thabane2,13,
  11. Zainab Samaan1,2
  1. 1Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  3. 3Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4Neurosciences Graduate Program, McMaster University, Hamilton, Ontario, Canada
  5. 5Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  6. 6Medical Science Gradaute Program, McMaster University, Hamilton, Ontario, Canada
  7. 7Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  8. 8Northern Ontario School of Medicine, Sudbury, Ontario, Canada
  9. 9Canadian Addiction Treatment Centres, Markham, Ontario, Canada
  10. 10ICES North, Sudbury, Ontario, Canada
  11. 11Health Sciences North Research Institute, Sudbury, Ontario, Canada
  12. 12Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
  13. 13Biostatistics Unit, Research Institute at St Joseph’s Healthcare, Hamilton, Ontario, Canada
  1. Correspondence to Dr Zainab Samaan; samaanz{at}mcmaster.ca

Abstract

Objectives Existing methods of measuring effectiveness of pharmacological treatment for opioid use disorder (OUD) are highly variable. Therefore, understanding patients’ treatment goals is an integral part of patient-centred care. Our objective is to explore whether patients’ treatment goals align with a frequently used clinical outcome, opioid abstinence.

Design Triangulation mixed-methods design.

Setting and participants We collected prospective data from 2030 participants who were receiving methadone or buprenorphine-naloxone treatment for a diagnosis of OUD in order to meet study inclusion criteria. Participants were recruited from 45 centrally-managed outpatient opioid agonist therapy clinics in Ontario, Canada. At study entry, we asked, ‘What are your goals in treatment?’ and used NVivo software to identify common themes.

Primary outcome measure Urine drug screens (UDS) were collected for 3 months post-study enrolment in order to identify abstinence versus ongoing opioid use (mean number of UDS over 3 months=12.6, SD=5.3). We used logistic regression to examine the association between treatment goals and opioid abstinence.

Results Participants had a mean age of 39.2 years (SD=10.7), 44% were women and median duration in treatment was 2.6 years (IQR 5.2). Six overarching goals were identified from patient responses, including ‘stop or taper off of treatment’ (68%), ‘stay or get clean’ (37%) and ‘live a normal life’ (14%). Participants reporting the goal ‘stay or get clean’ had lower odds of abstinence at 3 months than those who did not report this goal (OR=0.73, 95% CI 0.59 to 0.91, p=0.005). Although the majority of patients wanted to taper off or stop medication, this goal was not associated with opioid abstinence, nor were any of their other goals.

Conclusions Patient goals in OUD treatment do not appear to be associated with programme measures of outcome (ie, abstinence from opioids). Future studies are needed to examine outcomes related to patient-reported treatment goals found in our study; pain management, employment, and stopping/tapering treatment should all be explored.

  • adult psychiatry
  • substance misuse
  • qualitative research

Data availability statement

Data are available upon reasonable request. The data sets used during the current study are available from the corresponding author on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-044017

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    Data availability statement

    Data are available upon reasonable request. The data sets used during the current study are available from the corresponding author on reasonable request.

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    Footnotes

    • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

    • Contributors TR, LN, BP, NS, BD and ZS are responsible for the study concept and design. TR, BP, LT and ZS developed the methods and data analysis. TR conducted quantitative analysis and BP conducted qualitative analysis. TR wrote the first draft of the manuscript, and TR, LN, BP, DC, NS, BD, DM, LR, AW, LT and ZS, contributed to writing and critically revising the final manuscript. All authors reviewed and approved the final manuscript.

    • Funding This study was supported by research grants from the Canadian Institutes for Health Research (grant numbers PJT-156306 and SHI-155404).

    • Competing interests Dr David C. Marsh reports Salary income as Chief Medical Director, Canadian Addiction Treatment Centres and as Associate Dean Research, Innovation and International Relations, Northern Ontario School of Medicine.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.