Understanding patient capacity to meet the demands of methadone maintenance treatment from the perspectives of long-term opioid dependent women and men

Patient-centered care (PCC) is beginning to recognize the demands associated with chronic disease management and patient’s capacities to meet treatment demands. Opioid substitution treatment is recommended for long-term heroin injectors who cannot reach abstinence; the most widespread in Western countries is methadone maintenance treatment (MMT). This study seeks to explore long-term opioid-dependent patient’s perceived capacity to meet the demands of MMT.   

The Gender Matters study (Vancouver, Canada) was conducted with 178 long-term opioid-dependent women and men who had at least one prior MMT episode. Qualitative data from 11 focus groups (6 women; 5 men) were audio-recorded and transcribed regarding perceptions of MMT. Transcripts were coded independently by two researchers and a gender-specific inductive thematic analysis was carried out.

Demands of MMT were reflected in two major themes: daily time requirements and lack of PCC. Sub-themes revealed gender-specific findings; for example, men emphasized the inability to access take-home doses and the daily time required for treatment adherence.  For women, the lack of shared decision making and poor communication with healthcare providers affected perceived dose adequacy and motivation to adhere. Poor housing, chronic conditions (e.g., depression), and shame were perceived to affect capacity to meet MMTs demands.

People with chronic heroin dependency experience patterns of addiction, treatment, recovery and relapse. These findings improve understanding of what men and women with long-term opioid dependency perceive to challenge MMT adherence as well as the factors affecting capacity. This evidence informs further research regarding how these phenomena relate to clinical outcomes and potential PCC approaches.