Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency
Date
2011-07-26
Authors
Marchand, Kirsten I.
Oviedo-Joekes, Eugenia
Guh, Daphne
Brissette, Suzanne
Marsh, David C.
Schechter, Martin T.
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Substitution with opioid-agonists (e.g., methadone) has shown to be an effective treatment for
chronic long-term opioid dependency. Patient satisfaction with treatment has been associated with improved
addiction treatment outcomes. However, there is a paucity of studies evaluating patients’ satisfaction with Opioid
Substitution Treatment (OST). In the present study, participants’ satisfaction with OST was evaluated at 3 and 12
months. We sought to test the relationship between satisfaction and patients’ characteristics, the treatment
modality received and treatment outcomes.
Methods: Data from a randomized controlled trial, the North American Opiate Medication Initiative (NAOMI),
conducted in Vancouver and Montreal (Canada) between 2005-2008, was analyzed. The NAOMI study compared
the effectiveness of oral methadone vs. injectable diacetylmorphine over 12 months. A small sub-group of patients
received injectable hydromorphone on a double blind basis with diacetylmorphine. The Client Satisfaction
Questionnaire (CSQ-8) was used to measure satisfaction with treatment. CSQ-8 scores, as well as retention and
response to treatment, did not differ between those receiving hydromorphone and diacetylmorphine at 3 or 12
months assessments; therefore, these two groups were analyzed together as the ‘injectable’ treatment group.
Results: A total of 232 (92%) and 237 (94%) participants completed the CSQ-8 at 3 and 12 months, respectively.
Participants in both groups were highly satisfied with treatment. Independent of treatment group, participants
satisfied with treatment at 3 months were more likely to be retained at 12 months. Multivariate analysis indicated
that satisfaction was greater among those randomized to the injection group after controlling for treatment
effectiveness. Participants who were retained, responded to treatment, and had fewer psychological symptoms
were more satisfied with treatment. Finally, open-ended comments were made by 149 (60.3%) participants;
concerns about the randomization process and the study ending were most commonly reported by participants
receiving the oral and injectable medications, respectively.
Conclusions: The higher satisfaction among those receiving medically prescribed injectable diacetylmorphine (or
hydromorphone) supports current evidence regarding the attractiveness of this treatment for long-term, opioiddependent
individuals not benefiting sufficiently from other treatments. In addition, the measurement of treatment
satisfaction provides valuable information about participants at risk of relapse and in need of additional services.
Description
BioMed Central
Keywords
Citation
Marchand et al.: Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency. BMC Health Services Research 2011 11:174.