Is medical heroin sufficient to improve self-perceived quality of life of people with opioid addiction?

Background

Heroin-assisted treatment (HAT) is a substitution treatment intended for patients with heroin addiction where ordinary substitution treatment have not shown satisfactory effect. HAT involves supervised injections of medical heroin (diacetylmorphine) twice a day. HAT was established in Norway in 2022 as a pilot project in Bergen and Oslo. The project will be evaluated through research, and this study is part of the evaluation. Quality of life research among patients with drug addiction has mainly been quantitative. Internationally, patients' experience with HAT has been underreported. This study is the first qualitative study in Norway on the patients' experience of how HAT affects their self-perceived quality of life.

Method

We conducted semi-structured interviews with six HAT patients in Bergen, one month after the start of treatment and again six months into the treatment. The data was analyzed by performing reflexive thematic analysis as described by Braun and Clark (2006, 2019, 2021). We developed two main themes that accommodate patterns in the data material. These characterize a core idea and are organized around an overall concept.

Findings

After a dynamic process and systematic review of the data material, we developed two main themes: Theme 1: "HAT - A long-awaited measure that gives a better life", which is about how the informants feel that HAT makes life better than it was before; access to heroin makes life less stressful and they feel safer and more stabilized. Theme 2: "HAT - A highly intensive measure that demands a lot from the patients", is about the fact that the daily attendance and meetings with the staff and other patients in the clinic can be challenging. For each of the main themes 8 subthemes were also identified, 4 subthemes for each main theme. The informants nevertheless express that the advantages of being in HAT outweigh the disadvantages.

Conclusion

HAT as a stabilizing measure can contribute to patients experiencing a better quality of life by bringing them less stress related to their heroin addiction. Stable and safe access to heroin frees up time and money, and they feel freer. Despite the demanding nature of the treatment conditions, informants express that the benefits of participating in HAT outweigh the challenges. The difficulties they articulate are inherently tied to the addiction itself and could likely be further reduced by acknowledging the complexities of addiction disorders and by intensifying individualized psychosocial support beyond current practices.

Keywords : drug addiction, heroin-assisted treatment, user perspective, qualitative interview study