Article Text

Original research
How do people who use drugs experience treatment? A qualitative analysis of views about opioid substitution treatment in primary care (iCARE study)
  1. Paula Cristina Gomes Alves1,2,
  2. Fiona A Stevenson2,
  3. Sophie Mylan2,
  4. Nuno Pires3,4,
  5. Adam Winstock5,
  6. Chris Ford6
  1. 1Institute for Lifecourse Development, University of Greenwich, London, UK
  2. 2Primary Care and Population Health, University College London, London, UK
  3. 3Higher Institute of Social Work of Porto, Senhora da Hora, Portugal
  4. 4Lusiada Research Center on Social Work and Social Intervention, Lusiada University of Lisbon, Lisboa, Portugal
  5. 5Epidemiology and Public Health, University College London, London, UK
  6. 6International Doctors for Healthier Drug Policies, London, UK
  1. Correspondence to Dr Paula Cristina Gomes Alves; p.c.gomesalves{at}


Objective To understand the most significant aspects of care experienced by people in opioid substitution treatment (OST) in primary care settings.

Design Semistructured individual interviews were conducted, following the critical incidents technique. Interview transcripts were analysed following a thematic analysis approach.

Participants Adults aged 18 years or older, receiving OST in UK-based primary care services.

Results Twenty-four people in OST were interviewed between January and March 2019. Participants reported several aspects which were significant for their treatment, when engaging with the primary care service. These were grouped into 10 major themes: (1) humanised care; (2) individual bond/connection with the professional; (3) professionals’ experience and knowledge; (4) having holistic care; (5) familiarity; (6) professionals’ commitment and availability to help; (7) anonymity; (8) location; (9) collaborative teamwork; and (10) flexibility and changes around the treatment plan.

Conclusions This study included first-hand accounts of people who use drugs about what supports them in their recovery journey. The key lessons learnt from our findings indicate that people who use drugs value receiving treatment in humanised and destigmatised environments. We also learnt that a good relationship with primary care professionals supports their recovery journey, and that treatment plans should be flexible, tailor-made and collaboratively designed with patients.

  • opiate substitution treatment
  • primary health care
  • qualitative research
  • experiences of care

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  • Contributors All authors of this manuscript contributed significantly to the work presented, as follows: conception and design of the work by PCGA, FAS, SM, NP AW and CF; acquisition, analysis and interpretation of data by PCGA, SM and NP; drafting the manuscript and revising it critically for important intellectual content by PCGA, FAS, SM, NP AW and CF; final approval of the version to be published by PCGA, FAS, SM, NP AW and CF; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved by PCGA, FAS, SM, NP AW and CF.

  • Funding This work was supported by the National Institute for Health Research School of Primary Care Research, Project No 406 (Reference: SPCR-2014-10043), co-led by PCGA and FAS.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was granted from the NHS Health Research Authority/Hampstead Research Ethics Committee (18/LO/1402).

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

  • Data availability statement No data are available. The experiences of people discussed during the interviews refer to sensitive and personally relevant stories, and it was agreed that any transcripts would be made available to the research team only, and not publicly shared to ensure full protection and anonymity of study participants.

  • 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.