Aims: The aim of this exploratory analysis of European Quality Audit of Opioid Treatment data was to identify areas of improvement for current opioid maintenance treatment (OMT) approaches. Methods: Factors facilitating treatment entry, retention and refusal were compared between 8 European countries and between OMT patient (OMT-P) and active opioid user (AOU) sample groups. Both groups were divided into those who had never had OMT before (un-experienced OMT-P (n = 573) and AOU (n = 360)) and those who had been maintained at least once prior to this investigation (experienced OMT-P (n = 746) and AOU (n = 377)). Results: The European comparison showed that motives for starting OMT vary distinctly between countries (p ≤ 0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT. Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p ≤ 0.05). Conclusion: Increasing awareness of potential shortcomings of OMT delivery systems is crucial to optimally match treatment approaches to patient needs and also to reduce the considerable economic burden of addiction to society.

Keywords:
Opioid maintenance treatment, Europe, Opioid use disorder
1.
Wittchen H, Jacobi F, Rehm J, et al: The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;9:655-679.
2.
Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jönsson B: The economic cost of brain disorders in Europe. Eur J Neurol 2012;19:155-162.
3.
World Health Organization (WHO): Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. 2010. www.who.int. http://whqlibdoc.who.int/publications/2009/9789241547543_eng.pdf (accessed May 27, 2013).
4.
Amato L, Minozzi S, Davoli M, Vecchi S, et al: Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database Syst Rev 2008;4:CD004147.
5.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fith Edition (DSM-5). Arlington, American Psychiatric Publishing, 2013.
6.
McLellan A, Lewis D, O'Brien C, Kleber HD: Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA 2000;284:1689-1695.
7.
Weiden P, Glazer W: Assessment and treatment selection for ‘revolving door' inpatients with schizophrenia. Psychiatr Q 1997;68:377-392.
8.
Schaub D, Brüne M, Jaspen E, Pajonk FG, Bierhoff HW, Juckel G: The illness and everyday living: close interplay of psychopathological syndromes and psychosocial functioning in chronic schizophrenia. Eur Arch Psychiatry Clin Neurosci 2011;261:85-93.
9.
Koechl B, Danner S, Jagsch R, Brandt L, Fischer G: Health-related and legal interventions: a comparison of allegedly delinquent and convicted opioid addicts in Austria. Drug Science, Policy and Law 2014;1:2050324514528449.
10.
Mancia G, Laurent S, Agabiti-Rosei E, et al: Reappraisal of European guidelines on hypertension management: a European society of hypertension task force document. Blood press 2009;6:308-347.
11.
Meierkord H, Boon P, Engelsen B, et al: EFNS guideline on the management of status epilepticus in adults. Eur J Neurol 2010;17:348-355.
12.
Giacomuzzi SM, Riemer Y, Ertl M, et al: Buprenorphine versus methadone maintenance treatment in an ambulant setting: a health-related quality of life assessment. Addiction 2003;98:693-702.
13.
Gowing LR, Farrell M, Bornemann R, Sullivan LE, Ali RL: Brief report: methadone treatment of injecting opioid users for prevention of HIV infection. J Gen Intern Med 2006;21:193-195.
14.
Mattick RP, Ali R, White JM, O'Brien S, Wolk S, Danz C: Buprenorphine versus methadone maintenance therapy: a randomized double-blind trial with 405 opioid-dependent patients. Addiction 2003;98:441-452.
15.
Mattick RP, Breen C, Kimber J, Davoli M: Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev 2009;3:CD002209.
16.
Mattick RP, Kimber J, Breen C, Davoli M: Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2008;2:CD002207.
17.
Lynch FL, McCarty D, Mertens J, et al: Costs of care for persons with opioid dependence in commercial integrated health systems. Addict Sci Clin Pract 2014;9:16.
18.
Dale-Perera A, Goulão J, Stöver H: Quality of care provided to patients receiving opioid maintenance treatment in Europe: results from the EQUATOR analysis. Heroin Addict Relat Clin Probl 2012;14:23-38.
19.
Fischer G, Nava F, Stöver H: Outcomes of opioid-dependence treatment across Europe: identifying opportunities for improvement. Heroin Addict Relat Clin Probl 2012;14:39-50.
20.
Fischer G, Stöver H: Assessing the current state of opioid-dependence treatment across Europe: methodology of the European quality audit of opioid treatment (EQUATOR) project. Heroin Addict Relat Clin Probl 2012;14:5-70.
21.
Goulão J, Stöver H: The profile of patients, out-of-treatment users, and treating physicians involved in opioid maintenance treatment in Europe. Heroin Addict Relat Clin Probl 2012;14:7-22.
22.
Gowing L, Farrell MF, Bornemann R, Sullivan LE, Ali R: Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev 2011;8:CD004145.
23.
Booth RE, Corsi KF, Mikulich-Gilbertson SK: Factors associated with methadone maintenance treatment retention among street-recruited injection drug users. Drug Alcohol Depend 2004;74:177-185.
24.
Simpson DD, Joe GW: Motivation as a predictor of early dropout from drug abuse treatment. Psychotherapy 1993;30:357-367.
25.
Simpson DD, Joe GW, Rowan-Szal GA: Drug abuse treatment retention and process effects on follow-up outcomes. Drug Alcohol Depend 1997;47:227-235.
26.
Joe GW, Simpson DD, Broome KM: Effects of readiness for drug abuse treatment on client retention and assessment of process. Addiction 1998;93:1177-1190.
27.
Bukten A, Skurtveit S, Waal H, Clausen T: Factors associated with dropout among patients in opioid maintenance treatment (OMT) and predictors of re-entry. A national registry-based study. Addict Behav 2014;39:1504-1509.
28.
Wang PW, Wu HC, Lin HC, Yen CN, Yeh YC, Chung KS, Chang HC, Yen CF: Can heroin-dependent individuals benefit from a methadone maintenance treatment program before they drop out against medical advice? A 12-month follow-up study. Eur Addict Res 2013;19:155-164.
29.
Chalmers J, Ritter A: Subsidising patient dispensing fees: the cost of injecting equity into the opioid pharmacotherapy maintenance system. Drug Alcohol Rev 2012;31:911-917.
30.
Giraudon I, Vicente J, Matias J, Mounteney J, Griffiths P: Reducing drug related mortality in Europe - a seemingly intractable public health issue. Adicciones 2012;24:3-7.
31.
European Monitoring Centre for Drugs and Drug Addiction: European Drug Report: Trends and Developments, 2014.
32.
Stöver H: Assessing the current state of public-health-related outcomes in opioid dependence across Europe: data from the EQUATOR analysis. Heroin Addict Relat Clin Probl 2012;14:51-64.
33.
European Monitoring Centre for Drugs and Drug Addiction: Polydrug Use: Patterns and Responses. Luxembourg, EMCDDA, 2009.
34.
Metz VE, Brandt L, Unger A, Fischer G: Substance abuse/dependence treatment: a European perspective. Subst Abus 2014;35:309-320.
35.
Benyamina A, Stöver H: Barriers to treatment access and informed patient choice in the treatment of opioid dependence in Europe. Heroin Addict Relat Clin Probl 2012;14:65-80.
36.
Notley C, Blyth A, Maskrey V, Craig J, Holland R: The experience of long-term opiate maintenance treatment and reported barriers to recovery: a qualitative systematic review. Eur Addict Res 2013;19:287-298.
37.
Ajayi T: Drug misuse and dependence: UK guidelines on clinical management. Psychiatr Bull R Coll Psychiatr 2008;9:360.
38.
Bundesärztekammer: Richtlinien der bundesärztekammer zur durchführung der substitutionsgestützten behandlung opiatabhängiger. 2010. http://www.bundesaerztekammer.de/downloads/RL-Substitution_19-Februar-2010.pdf (accessed August 18, 2014).
39.
Kelly SM, O'Grady KE, Mitchell SG, Brown BS, Schwartz RP: Predictors of methadone treatment retention from a multi-site study: a survival analysis. Drug Alcohol Depend 2011;117:170-175.
40.
Harm Reduction International: The global state of harm reduction: towards an integrated response. 2012. http://www.ihra.net/files/2012/07/24/GlobalState2012_Web.pdf (accessed November 14, 2014).
41.
The REDUCE Project: Reducing hepatitis C injecting and sexual risk behaviours among females who inject drugs in Europe (REDUCE): translating evidence into practice. Final report, 2013. 2013. http://www.thereduceproject.imim.es/files/final/English_REDUCE_final_report.pdf (accessed December 4, 2014).
42.
Gjersing L, Waal H, Röislien J, Gossop M, Clausen T: Variations in treatment organisation, practices and outcomes within the Norwegian opioid maintenance treatment programme. Norsk Epidemologi 2011;21:113-118.
43.
Beardsley K, Wish ED, Fitzelle DB, O'Grady K, Arria AM: Distance traveled to outpatient drug treatment and client retention. J Subst Abuse Treat 2003;25:279-285.
44.
Greenfield L, Brady JV, Besteman KJ, De Smet A: Patient retention in mobile and fixed-site methadone maintenance treatment. Drug Alcohol Depend 1996;42:125-131.
45.
Gerra G, Saenz E, Busse A, et al: Supervised daily consumption, contingent take-home incentive and non-contingent take-home in methadone maintenance. Prog Neuropsychopharmacol Biol Psychiatry 2011;35:483-489.
46.
King VL, Kidorf MS, Stoller KB, Schwartz R, Kolodner K, Brooner RK: A 12-month controlled trial of methadone medical maintenance integrated into an adaptive treatment model. J Subst Abuse Treat 2006;31:385-393.
47.
Johnson B, Richert T: Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: prevalence estimates and risk factors. Int J Drug Policy 2015;26:183-190.
48.
Uchtenhagen A, Schaub M: Minimum quality standards in drug demand reduction EQUS. Final Report, 2011. http://www.isgf.ch/fileadmin/downloads/EQUS_final_report.pdf (accessed December 9, 2014).
49.
Deering D, Horn J, Frampton CM: Clients' perceptions of opioid substitution treatment: an input to improving the quality of treatment. Int J Ment Health Nurs 2012;21:330-339.
50.
Roux P, Villes V, Blanche J, et al: Buprenorphine in primary care: risk factors for treatment injection and implications for clinical management. Drug Alcohol Depend 2008;97:105-113.
51.
D'Aunno T, Pollack HA, Frimpong JA, Wuchiett D: Evidence-based treatment for opioid disorders: a 23-year national study of methadone dose levels. J Subst Abuse Treat 2014;47:245-250.
52.
HM Government: Drug Strategy 2010: Reducing demand, restricting supply, building recovery: supporting people to live a drug free life. 2010. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/118336/drug-strategy-2010.pdf (accessed August 18, 2014).
53.
European Comission: Unemployment statistics. 2014. http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Unemployment_statistics (accessed September 12, 2014).
54.
Deck D, Carlson MJ: Retention in publicly funded methadone maintenance treatment in two Western States. J Behav Health Serv Res 2005;32:43-60.
55.
Magura S, Nwakeze PC, Demsky SY: Pre- and in-treatment predictors of retention in methadone treatment using survival analysis. Addiction 1998;93:51-60.
56.
Metz V, Schwarz B, Fischer G: Kosten der Medizinischen Behandlung von Substanzabhängigkeit. Therapie Statt Strafe. Gesundheitsbezogene Maßnahmen bei Substanzabhängigkeit und Suchtmittel(straf)recht. Vienna, NWV, 2012.
57.
European Monitoring Centre for Drugs and Drug Addiction: Harm reduction: evidence, impacts and challenges. 2010. www.emcdda.europa.eu. http://www.emcdda.europa.eu/publications/monographs/harm-reduction (accessed May 27, 2013).
58.
Degenhardt L, Larney S, Kimber J, et al: The impact of opioid substitution therapy on mortality post-release from prison: retrospective data linkage study. Addiction 2014;109:1306-1317.
59.
Clausen T, Anchersen K, Waal H: Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug Alcohol Depend 2008;94:151-157.
60.
Degenhardt L, Randall D, Hall W, Law M, Butler T, Burns L: Mortality among clients of a state-wide opioid pharmacotherapy program over 20 years: risk factors and lives saved. Drug Alcohol Depend 2009;105:9-15.
61.
Hedrich D, Farrell M: Opioid maintenance in European prisons: is the treatment gap closing? Addiction 2012;107:461-463.
62.
Dale-Perera A, Alam F, Barker P: Opioid-dependence treatment in the era of recovery: insights from a UK survey of physicians, patients and out-of-treatment opioid users. J Subst Use 2014, DOI: 10.3109/14659891.2014.923532.
63.
Gesundheit Österreich GmbH, Bundesministerium für Gesundheit: Epidemiologiebericht Drogen, 2014.
64.
EMCDDA: Statistical bulletin 2013. 2013. http://www.emcdda.europa.eu//stats13/list (accessed March 5, 2015).
65.
Roncero C, Fuste G, Barral C, Rodríguez-Cintas L, Martínez-Luna N, Eiroa-Orosa FJ, Casas M; PROTEUS Study Investigators: Therapeutic management and comorbidities in opiate-dependent patients undergoing a replacement therapy programme in Spain: the PROTEUS study. Heroin Addict Relat Clin Probl 2011;13:5-16.
66.
Jones A, Weston S, Moody A, Millar T, Dollin L, Anderson T, Donmall M: The drug treatment outcomes research study (DTORS): baseline report. Research report 3, 2007. www.dtors.org.uk (accessed March 5, 2015).
67.
Wittchen HU, Apelt SM, Soyka M, et al: Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: a naturalistic study in 2694 patients. Drug Alcohol Depend 2008;95:245-257.
68.
Wittchen HU, Bühringer G, Rehm J: Ergebnisse und schlussfolgerungen der PREMOS-studie (predictors, moderators and outcome of substitution treatment). Suchtmedizin in Forschung und Praxis 2011;13:199-299.
69.
European Monitoring Centre for Drugs and Drug Addction (EMCDDA): Drug treatment profiles. 2012. http://www.emcdda.europa.eu/responses/treatment-overviews (accessed December 9, 2014).
70.
United Nations, Department of Economic and Social Affaires: Population division, population estimates and projections section. 2012. http://esa.un.org/wpp/unpp/panel_population.htm (accessed December 18, 2014).
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