Self-rated health among patients in opioid agonist therapy

Background
Patients with opioid use disorders, including patients receiving opioid agonist therapy (OAT), have an increased burden of physical and mental health diseases compared to the general population. Yet, most of those do not seek or receive adequate healthcare for the health problems. Self-rated health, also referred to as self-perceived health, is regarded as an easy-to-use measure of a person’s general health in both research and clinical settings. In a Norwegian survey, nine percent of the general population adults, reported very poor/poor health, 17% reported fair health and 74% reported good/very good health. A corresponding assessment for patients receiving OAT is lacking.
Methods
ATLAS4LAR-study is a multicenter study conducted in the Norwegian cities of Bergen and Stavanger. As part of the study, annual health assessments were conducted in 2020-2023 with baseline data collected from 8 OAT clinics. Participants were asked to rate how they perceived their general health, using a single item question with five items response: «How is your health in general?», with answer alternatives very bad/bad/fair/good/very good. The questionnaire also included questions about age, sex, living conditions, education level, OAT medication, alcohol intake and substance use. In addition to descriptive data and percentages of different levels of self-rated health, a chi-square test was performed to examine the relation between self-rated health and sex, age, living conditions, OAT-medication, weekly use of alcohol or illegal substances. 
Results
We included 620 patients in this preliminary analysis. Seventy percent were male with mean age of 46 years. Relating to their self-rated health, 26% of the patients reported bad/very bad health, 36% reported fair health and 38% reported good/very good health. Bad/very bad health was reported by 13% of patients with unstable living condition and 27% in the group with stable living conditions (p<0.05). Among patients receiving methadone and morphine, 33% reported bad/very bad health compared to 22% of patients receiving buprenorphine (p=0.077). Self-perceived health was similar for people drinking alcohol once a week or not, and similarly also for cannabis. Among those with weekly use of amphetamine-type-stimulants, 21% reported bad/very bad health compared to 27% without weekly use (p=0.179). For weekly use of illegal benzodiazepines, 32% reported bad/very bad health compared to 24% among patients not using these (p=0.086). 
Conclusions
Our preliminary results indicates that patients receiving OAT more often report very bad/bad self-rated health compared to surveys of the general population. Our findings emphasize the need to identify possible underlying factors to improve self-rated health in this population.