What stops people on long-term opioid substitution from completing their treatment?

First published: 10 May 2019 | Last updated: 20 May 2019


To explore the lifestyle of opioid users, who were stable on substitute medication for longer than five years and provide a client-centred evaluation on reasons that makes it difficult for them to consider completion of treatment, to inform a newly implemented service focusing on their needs.


Ten clients were purposively sampled from a specifically developed clinic (JUNCTION clinic) as part of a community substance misuse service (iHEAR) in London, during February and March 2016. They were interviewed face to face using a semi-structured format. Detailed inductive coding and thematic analysis of all transcripts was conducted.

Results: Key themes identified were poor social engagement, challenges with relationships, treatment expectations and fear of change. Participants reported to be socially withdrawn, but to have close relationships with family. Most of them described poor education, lack of employment or involvement in any interactive roles. Most participants expressed fear of change to their treatment and in particular reduction of the prescribed substitute medication, due to past traumatic withdrawal experience, fear of relapse, fear of negative impact on their mental and physical health. Nevertheless all were optimistic about their future life and treatment plans and were hoping to be able to complete their treatment at some point.

Conclusion: The fear of change and risk of physical and mental health deterioration as well as past traumatic withdrawal experiences might have a significant role to play into the confidence and ability of clients on long-term substitution treatment to complete it. Results informed the themes of the discussion taking place in the group sessions, which are part of the JUNCTION clinic. A follow up interview with the same clients will take place 6 months later, to assess the perceived effectiveness of the clinic.


Paula Dendere, Mental Health Nurse in Addictions, iHEAR, Surrey and Borders Partnership NHS Foundation Trust Christos Kouimtsidis FRCPsych, MSc, PhD, Consultant Psychiatrist in Addictions, iHEAR, Surrey and Borders Partnership NHS Foundation Trust

Conflicts of interest:

Funding Sources: NA

No conflict of interest


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