Opioid maintenance treatment retention and perceptions of care among long-term opioid dependent men and women

Background: Opioid dependence is a chronic relapsing disease with a number of related harms. Despite the proven effectiveness of opioid maintenance many men and women are not engaged or retained in this treatment. Accounting for patient perceptions of their interactions with health care providers may offer important evidence as to meeting gender specific heath and treatment needs of this population. Objective: This thesis investigates access to health care and addiction treatment services among long-term opioid dependent men and women. Factors associated with retention to opioid maintenance treatment are explored among participants and stratified by gender. Perceptions of encounters with health care providers as potentially offensive, degrading, or abusive are considered. Finally, the feasibility of sharing study findings with long-term opioid users are explored. Methods: The Gender Matters in the Health of Long-term Opioid Users study is a descriptive cross-sectional study of long-term opioid users in the Downtown Eastside of Vancouver. Descriptive variables were explored and logistic regression models were built to determine associations between independent variables and the opioid maintenance treatment retention and perceived abuse in health care outcomes. Two formats of sharing study findings with participants were piloted and participant perceptions of study findings and the meeting formats were gathered. Results: Rates of opioid maintenance treatment retention were similar among men and women while factors associated with retention differed by gender. Half of participants reported perceived abuse in health care, which was associated with childhood maltreatment and psychological health problems. The majority of participants felt it was important for participants to be involved in knowledge translation, while few had previously had the opportunity to do so. Conclusions: Gender, along with other structural factors have strong implications for the appropriateness and success of the treatment and models of care provided to opioid-dependent men and women. Patient histories and perspectives must be accounted for to determine suitable treatments and to ensure health care encounters are not perceived as offensive, degrading, or abusive. The involvement of participants in knowledge translation can serve as a means of empowering participants and accounting for patient voice in recommendations for service provision and policy.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat