Monitoring opioid agonist maintenance treatment outcomes for people who use opioids and public health

Introduction and aims: Opioid agonist maintenance treatment (OAMT) is highly effective to reduce mortality and morbidity of people who use opioids (PWUO). Different outcome measures are used in different studies and countries, often excluding key public health outcomes (e.g. overdose, HIV/HCV). We aim to develop consensus indicators for OAMT outcomes monitoring guidance, which are relevant for PWUO and public health.

Design and methods: 80 OAMT experts (including with lived experience) from 28, mostly European, countries, prepared draft outcome indicators. A Delphi panel of 310 further experts (OAMT-professionals and PWUO, 18 countries) evaluated them.

Results: Fourteen indicators in six topic areas/dimensions: ‘Treatment’, ‘Physical Health and Risk Behaviour’, ‘Mental health’, ‘Social Health’, ‘Substance Use’ and ‘Quality of Life’, plus three ‘End-of-client-session-questions’. All indicators, dimensions and end-of-client-session-questions, scored on average around 5 (‘agree’) on a six-point Likert scale (25-75-percentile range: 4-6 /‘slightly agree’–‘strongly agree’). The panel indicated a need for more detailed answering options that fit better the different specific experiences of PWUO.

Discussions and conclusions: Future guidance based on these indicators should allow: a) incorporation of key (public) health problems of PWUO into OAMT outcome monitoring, b) better quality OAMT practice through standardised indicators and dimensions (with flexibility for the clinician to add or skip topics that are relevant /not relevant to PWUO), c) comparability of OAMT treatment outcomes between national and regional OAMT outcomes monitoring datasets.