Opioid substitution treatment - defining problems and solutions

Background: 

The Norwegian opioid substitution treatment (OST) program is, despite being considered one of the most successful measures for treating opioid addiction, a contested practice. The program’s official aims are to decrease mortality and increase quality of life, through giving people with a diagnosed opioid addiction a substitution medication in a highly controlled environment. The illicit drug use that the policy is aimed at, has long been situated within the crime-health-nexus. Today, OST is the only specialist health service with its own regulation.

Methods:

This paper explores the understandings of OST that inform the policy and practice central to defining goals and measuring the success of the program. This is done by using a broad policy analysis of regulations, national guidelines, and evaluations.

Results:

Preliminary results indicate that different actors define OST and what OST is a solution for in different ways. The policy documents also show how the aims of OST have not changed significantly during the three decades that it has been offered - in contrast to the practical implementation and target group. 

Conclusions:

Differing views of the deviant behavior of using opioids will inform what OST is a solution to and affect what the desired outcome of the program is. It can also impact the practical solution, and thus the services offered. Understanding the different views shaping the implementation is important to make visible the consequences this has on patients’ quality of life.