Health-related quality of life trajectories of patients in heroin-assisted treatment

Background

This study focuses on understanding health-related quality of life (HRQoL) of patients in heroin-assisted treatment (HAT) with opioid use disorder. While opioid maintenance treatment has been shown to enhance perceived HRQoL, specific HRQoL trajectories and factors influencing their change during HAT remain under-researched. This study aims to bridge this gap by identifying HRQoL trajectories of individuals engaging in HAT and examining factors associated with HRQoL class membership. 

Methods

This is a longitudinal cohort study based on the multicenter Norwegian HAT project. The study sample includes all consenting individuals enrolled in treatment from 1/1/2021 to 1/1/2024 who have completed the HRQoL component of the baseline questionnaire. HRQoL was assessed using the EuroQol EQ-5D-5L measure. Self-reported data on demographics, substance use, and physical and mental health were also collected using questionnaires at baseline and at multiple time points. A conservative preliminary analysis on a sample subset investigated differences in HRQoL between the baseline measure and the first follow-up at 3 months (mean days: 115, SD 41.6). Future planned analysis include latent class growth analysis to identify HRQoL trajectory classes over time, and multivariate analysis to identify time-invariant and time-varying predictors of class membership. 

Results

A total of 55 patients completed the baseline measurement. The mean age at HAT initiation was 46.7 (SD 9.9). The majority of patients were male (87%). 

At baseline, a substantial percentage of participants faced health challenges, with 51% experiencing mobility issues, 47% grappling with self-care, 62% encountering obstacles in usual activities, and high proportions reporting pain/discomfort (87%) and anxiety/depression (92%). Only one participant reported no problems across all areas. The group under 40 (n=15, 27%) exhibits the highest proportion of individuals facing problems in the mobility, self-care, and anxiety/depression dimensions.

Change in health state was analyzed for 39 patients who completed both the baseline and first follow-up. Only a small percentage (3%) showed no change, while 23% exhibited improvement in at least one dimension. Conversely, 18% experienced worsening conditions, and the majority (56%) demonstrated mixed changes (both improvements and deteriorations). Looking at the dimensions, “usual activity” reports the highest percentage of worsening (50%).

Conclusion

These findings emphasize the multifaceted nature of health concerns within our cohort at baseline. The preliminary findings at the first follow-up suggest that HAT may enhance HRQoL as for each dimension between 27% and 42% of the subsample reported improvements. Nevertheless, other subsets of patients demonstrated no change or worsening in specific dimensions, indicating variations in patterns and delineating distinct subgroups. Tailored interventions should be implemented for each subgroup to enhance HRQoL.