Alternatives to Direct Observed Therapy in the Treatment of Opioid Dependence – a Mixed Study in Portugal
Backgroud: Opioid addiction and its effects are of great concern, which has led to the creation of substitution programs, which aim to improve the quality of life of people who use drugs. This research not only aims to analyze the perspectives of beneficiaries and professionals on the impact of Directly Observed Therapy on methadone, but also their perspectives on alternative methods, such as take-home doses and Video Observed Therapy.
Methods: Thus, through a mixed study, the perspectives of patients (n = 33), and professionals (n = 37), were analyzed with the application of questionnaires and a focus group. Quantitative data were submitted to a simple descriptive statistical analysis, and qualitative data were transcribed and submitted to content analysis.
Results: Among the participants, several advantages of the alternative approaches to DOT were mentioned, which emerged as a way to ease the burden of DOT. Regarding take-home doses, the sample, in general, recognizes several advantages, which translate into ways of combating the numerous disadvantages of DOT. In this way, the following were highlighted: labor issues; obstacles to carrying out daily activities; flexible working hours; difficulties in traveling; stigma; social, family, and judicial issues. In addition to these, it is common in the results the belief that take-home doses can increase users' sense of autonomy, making it possible to respond to their daily needs, without the inconvenience of carrying out daily visits to services.
Regardind VOT, the sample seems to reach a consensus when putting into perspective its use at times. Thus, participants see VOT as a resource for monitoring administration and ensuring user well-being, which is considered important, especially with less structured people. Interestingly, VOT is seen as a potential ally for take-home doses, with many professionals reporting greater comfort with the possibility of this alliance, as it offers the opportunity to observe the intake.
Discussion: In this study, important results on dispensing doses are discussed, such as the need to increase the accessibility of this format to more beneficiaries. Furthermore, it is one of the pioneering studies about using VOT in the area of opioid addiction treatment, where it was possible to verify that people included in the treatment process consider this approach possible and advantageous, in certain circumstances. Therefore, despite proving the possibility of implementing these alternative approaches, it is urgent to study these issues at a deeper level, as DOT proves to be significantly detrimental to the quality of life of people who are in treatment.
This study is part of a wider investigation, resulting from a partnership of five institutions, having been approved by the Ethics Committee of ARS Norte.
