Improving the health and wellbeing of people who are not benefiting from long-term opioid substitute treatment

  • Sharmila Kumar

    Student thesis: Doctoral Thesis


    In the UK, opioid substitute treatment (OST) is an important intervention that is used to treat heroin or illicit opioid dependency. Research has shown that OST is highly beneficial for both individuals who are struggling with their heroin use and society. However, there is growing recognition that there is a significant proportion of long-term OST patients with complex needs who are struggling to achieve benefits from treatment. Relatively little is known about the reasons why this is the case. The research presented in this thesis aimed to fill this gap in knowledge by improving understanding of the barriers to success faced by this cohort and how these barriers can be overcome to improve the health and wellbeing of OST patients. To achieve these aims, a qualitative study was conducted that involved: 1) in-depth interviews with 38 OST patients who had been engaged with OST for five years or more on a continuous or intermittent basis, 2) in-depth interviews with 20 staff members who had direct experience of working with the above-mentioned population, and 3) a ‘microethnography’of a busy drug treatment service operating across South Wales.

    This is the first time that Zinberg’s (1984) drug, set and setting theoretical framework has been used in the exploration of barriers to treatment success in the long-term OST population and how these barriers can be addressed by treatment services. The findings show that drug, set and setting barriers interact in complex ways to affect the health and wellbeing of the OST patient. The lack of appropriate support to address the complex needs of the OST patient, the failure of treatment services to provide adequate time that meets the complex needs of OST patients, the absence of opportunities for integration within treatment services, the failure of treatment services to provide an individualised approach and the negative impact of treatment rules/regulations on OST patients’ lives are important barriers that affect the wellbeing of the OST patient. The provision of appropriate support that meets the complex needs of OST patients and reintegration opportunities with society could help to promote progression in treatment. Additionally, the administration of Buvidal (depot form OST) and the adoption of an individualised approach could help to meet the diverse needs of the OST population. The findings of this study have important implications for treatment services, drug policy, legislation and harm reduction.
    Date of Award2022
    Original languageEnglish
    SupervisorKaty Holloway (Supervisor) & Marian Buhociu (Supervisor)

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