Risk factors associated with noncompliance with methadone substitution therapy (MST) and relapse among chronic opiate users in an Outer London community
Aims. The purpose of this study was to identify the risk factors associated with noncompliance with methadone substitution therapy (MST) and hence relapse in chronic opiate-dependent users, as this has major clinical implications especially in community-based detoxification programmes.
Background. Community mental health nurses (CMHNs) and other health/social care professionals need to be aware of the main risk factors associated with MST noncompliance among long-term opiate users living within their catchment areas. The sex-matched patterns of biopsychosocial risk factors can be useful predictors of the ability of clients to comply with MST and their likelihood to complete the detoxification programme. A knowledge of the patterns of these high-risk factors also allows the care professionals to: (1) draw-up or re-draw care contracts that reflect their patients’ biopsychosocial circumstances; (2) initiate much broader, client-centred, relapse prevention strategies; (3) select suitable patients for specialized detoxification contracts; and (4) modify the care approach from detoxification to maintenance contracting particularly for clients with low predicted scores for the former contract-type.
Methods. As successfully demonstrated in this semi-quantitative descriptive investigation, identification of these sex-typed biopsychosocial high-risk factors can easily be undertaken during assessment and when the clients attend regular review. In this study, numerical information was gathered during personal face-to-face interviews, and was supplemented with that contained in past multidisciplinary case notes.
Results. Overall, the medication noncompliant female clients were associated with personality trait, decreased educational expectations, everyday life stresses, ambivalent thoughts, social company availability, comorbidity, boredom, and family-related conflicts; whereas the noncompliant male clients were associated with poor motivation, fashion and reputation, peer association, uncontrollable drug-cravings, drug availability, major life events, too stringent prescribing/poor client-centred care package, heavy intravenous users, young polydrug users, and triple users.
Conclusions. These findings have important nursing practice connotations. This study is advocating the routine identification of biopsychosocial high-risk factors associated with MST noncompliance by all CMHNs working with chronic opiate-dependent users.