What is success in treatment for opioid use disorder? Perspectives of physicians and patients in primary care settings

Stephanie A. Hooker; Michelle D. Sherman; Mary Lonergan-Cullum; Tanner Nissly; Robert Levy

doi:10.1016/j.jsat.2022.108804

What is success in treatment for opioid use disorder? Perspectives of physicians and patients in primary care settings

Stephanie A. Hooker, Michelle D. Sherman, Mary Lonergan-Cullum, Tanner Nissly, Robert Levy

Family Medicine and Community Health (Twin Cities)

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Introduction: Clinicians and researchers have traditionally relied on treatment retention and opioid abstinence as the primary measures of treatment success for people with opioid use disorder (OUD). However, these measures may not capture the range of clinically important treatment outcomes. The study sought to identify indicators of success in primary care–based medication for OUD (MOUD) treatment from the perspectives of patients with OUD and the physicians who treat them. Methods: The study recruited patients (N = 18; M age = 38.1 years, SD = 11.5; 44% female) and physicians (N = 14; M age = 34.6, SD = 6.8 years; 57% female) from two academic family medicine residency clinics in the upper Midwest to participate in semi-structured qualitative interviews. Participants reflected on signs of progress and success in primary care MOUD treatment. Interviews were recorded, transcribed, and analyzed using an inductive thematic analysis approach. Results: Seven themes of success emerged: (1) staying sober; (2) tapering off buprenorphine; (3) taking steps to improve physical and mental health; (4) improved psychological well-being; (5) improved relationships; (6) improved role functioning; and (7) decreased stigma and shame. Interviews with both patients and physicians supported five of the seven themes, with patients also describing themes of tapering off buprenorphine and reduced stigma and shame. Conclusions: Themes suggest that a wider view of success, in addition to maintaining sobriety, is needed when considering outcomes for MOUD programs delivered in primary care settings. Future work should identify appropriate outcome measures and potential adjunctive treatments.

Original language	English (US)
Article number	108804
Journal	Journal of Substance Abuse Treatment
Volume	141
DOIs	https://doi.org/10.1016/j.jsat.2022.108804
State	Published - Oct 2022

Bibliographical note

Funding Information:
We would like to thank Kristin Norderud for her assistance with qualitative interviews. We would also like to thank Dr. Ian Latham for his ideas on the discussion section. This work was supported by the Substance Abuse and Mental Health Administration State Opioid Response Grant through the Minnesota Department of Human Services (H79TI080248) to RL. The Minnesota Department of Human Services and the Substance Abuse Mental Health Administration had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Funding Information:
This work was supported by the Substance Abuse and Mental Health Administration State Opioid Response Grant through the Minnesota Department of Human Services ( H79TI080248 ) to RL. The Minnesota Department of Human Services and the Substance Abuse Mental Health Administration had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Publisher Copyright:
© 2022 Elsevier Inc.

Keywords

Buprenorphine
Medications for opioid use disorder
Primary care
Qualitative research
Substance use disorder
Treatment outcomes

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jsat.2022.108804

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title = "What is success in treatment for opioid use disorder? Perspectives of physicians and patients in primary care settings",

abstract = "Introduction: Clinicians and researchers have traditionally relied on treatment retention and opioid abstinence as the primary measures of treatment success for people with opioid use disorder (OUD). However, these measures may not capture the range of clinically important treatment outcomes. The study sought to identify indicators of success in primary care–based medication for OUD (MOUD) treatment from the perspectives of patients with OUD and the physicians who treat them. Methods: The study recruited patients (N = 18; M age = 38.1 years, SD = 11.5; 44% female) and physicians (N = 14; M age = 34.6, SD = 6.8 years; 57% female) from two academic family medicine residency clinics in the upper Midwest to participate in semi-structured qualitative interviews. Participants reflected on signs of progress and success in primary care MOUD treatment. Interviews were recorded, transcribed, and analyzed using an inductive thematic analysis approach. Results: Seven themes of success emerged: (1) staying sober; (2) tapering off buprenorphine; (3) taking steps to improve physical and mental health; (4) improved psychological well-being; (5) improved relationships; (6) improved role functioning; and (7) decreased stigma and shame. Interviews with both patients and physicians supported five of the seven themes, with patients also describing themes of tapering off buprenorphine and reduced stigma and shame. Conclusions: Themes suggest that a wider view of success, in addition to maintaining sobriety, is needed when considering outcomes for MOUD programs delivered in primary care settings. Future work should identify appropriate outcome measures and potential adjunctive treatments.",

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note = "Funding Information: We would like to thank Kristin Norderud for her assistance with qualitative interviews. We would also like to thank Dr. Ian Latham for his ideas on the discussion section. This work was supported by the Substance Abuse and Mental Health Administration State Opioid Response Grant through the Minnesota Department of Human Services (H79TI080248) to RL. The Minnesota Department of Human Services and the Substance Abuse Mental Health Administration had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Funding Information: This work was supported by the Substance Abuse and Mental Health Administration State Opioid Response Grant through the Minnesota Department of Human Services ( H79TI080248 ) to RL. The Minnesota Department of Human Services and the Substance Abuse Mental Health Administration had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

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AU - Lonergan-Cullum, Mary

AU - Nissly, Tanner

AU - Levy, Robert

N1 - Funding Information: We would like to thank Kristin Norderud for her assistance with qualitative interviews. We would also like to thank Dr. Ian Latham for his ideas on the discussion section. This work was supported by the Substance Abuse and Mental Health Administration State Opioid Response Grant through the Minnesota Department of Human Services (H79TI080248) to RL. The Minnesota Department of Human Services and the Substance Abuse Mental Health Administration had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Funding Information: This work was supported by the Substance Abuse and Mental Health Administration State Opioid Response Grant through the Minnesota Department of Human Services ( H79TI080248 ) to RL. The Minnesota Department of Human Services and the Substance Abuse Mental Health Administration had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Publisher Copyright: © 2022 Elsevier Inc.

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N2 - Introduction: Clinicians and researchers have traditionally relied on treatment retention and opioid abstinence as the primary measures of treatment success for people with opioid use disorder (OUD). However, these measures may not capture the range of clinically important treatment outcomes. The study sought to identify indicators of success in primary care–based medication for OUD (MOUD) treatment from the perspectives of patients with OUD and the physicians who treat them. Methods: The study recruited patients (N = 18; M age = 38.1 years, SD = 11.5; 44% female) and physicians (N = 14; M age = 34.6, SD = 6.8 years; 57% female) from two academic family medicine residency clinics in the upper Midwest to participate in semi-structured qualitative interviews. Participants reflected on signs of progress and success in primary care MOUD treatment. Interviews were recorded, transcribed, and analyzed using an inductive thematic analysis approach. Results: Seven themes of success emerged: (1) staying sober; (2) tapering off buprenorphine; (3) taking steps to improve physical and mental health; (4) improved psychological well-being; (5) improved relationships; (6) improved role functioning; and (7) decreased stigma and shame. Interviews with both patients and physicians supported five of the seven themes, with patients also describing themes of tapering off buprenorphine and reduced stigma and shame. Conclusions: Themes suggest that a wider view of success, in addition to maintaining sobriety, is needed when considering outcomes for MOUD programs delivered in primary care settings. Future work should identify appropriate outcome measures and potential adjunctive treatments.

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What is success in treatment for opioid use disorder? Perspectives of physicians and patients in primary care settings

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Access

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