"Holding on by the seat of their pants" A Mixed methods exploration of retention, completion and recovery in opioid substitution treatment

To understand which factors and processes influence the concepts of recovery, retention and completion in opioid substation treatment. Understanding these factors better will inform the development of targeted interventions to improve outcomes in this population.

There are an estimated 340,000 high-risk opioid users in the UK and almost 150,000 people receiving opioid substitution treatment (OST). Recovery outcomes in OST are poorer than those for treatment for alcohol and other drug problems. We know that being retained in OST is associated with many benefits, including a reduction in the transmission of viruses such as HIV and Hepatitis C as well as reducing the risk of overdose; however treatment services are under increasing financial and political pressure to encourage more people to complete OST and taper off medications.

At a time when opioid related deaths in the United Kingdom are at their highest ever level, it is key that we understand which clinical and demographic factors are associated with completing treatment as well as the psychological and socioecological processes that underly concepts such as treatment retention, discharge and ‘recovery’.

This project has used mixed methods which has enabled the researcher to triangulate a wider range of evidence and take a pragmatic stance to answering the project’s research questions. This has involved  a systematic review and thematic synthesis of 37 qualitative studies looking at recovery in OST, followed by an observational cohort study of routinely collected data using survival analysis and logistic regression to estimate treatment duration and to characterise the treatment population.

The results of these two studies then informed the topic guides for the final study – 25 in-depth interviews with OST service users, staff and key stakeholders in Bristol. The project has used a reflective Thematic Analysis (Braun & Clarke, 2019) as it is theoretically flexible and well-suited to a novice qualitative researcher.

This project has involved a OST service user which has provided invaluable insights. The PPI representative has contributed to the development of participant materials such as topic guides and has acted as a sounding board for my interpretation of the data.

The results of the work will be disseminated to service users and staff at Bristol Drugs Project via presentations and leaflets. Preliminary results have been shared throughout the PhD with Bristol’s Drug and Alcohol Health Integration Team (HIT). I have also presented findings at academic conferences and will publish the results of the systematic review and qualitative in academic journals.