Aims To study advantages and disadvantages of less regulated models of opioid substitution treatment.
Design Interview and questionnaire data of patients and personnel of five Finnish outpatient clinics in 2009, one year after the national regulations had been changed to allow less controlled treatment models. Data includes evaluation of the current situation of 111 patients by personnel, interviews of 75 patients; group interviews of personnel.
Participants 75 patients were interviewed (75% males, mean age 32, ½ -8 years in treatment).
Measurements Life-situation and history of the patients, situation in treatment, description and evaluation of the treatment by patients and personnel.
Findings Most patients were unemployed, and had psychiatric problems. They had heavy drug use history, and many of them continued to use some other drugs regardless of urine screening. After careful evaluation of the situation of the patients, only few patients progressed towards pharmacy distribution. Some patients were transferred to harm reduction treatment model. However, numerous patients were not removed to less regulated treatment procedures either because of their insistent personal need for psychosocial treatment or because of the concerns of the personnel.
Conclusions Changing to less regulated models of opioid substitution treatment is more difficult and time consuming than was expected. Even though economic pressure for change is heavy, variety of treatment models, careful evaluation of the situation of the patients, and education of the personnel of pharmacies, clinics and health centres is needed.
Tuuli Pitkänen and Teemu Kaskela at Järvenpää Addiction Hospital, A-Clinic Foundation, Finland
