Non-financial barriers in oral health care: a qualitative study of patients receiving opioid maintenance treatment and professionals’ experiences

Background People with substance use disorders often have poor oral health, which can negatively impact their quality of life. Since 2005, patients receiving opioid maintenance treatment (OMT) in Norway have been eligible for free oral health care services offered through public oral health clinics. Despite a large need for oral health services amongst patients in OMT, figures suggest that the use of these services is low amongst this patient group. It has been unclear which barriers that contribute to this. This qualitative study explores the underlying barriers to the use of oral health care services amongst patients in OMT, from the perspective of the patients as well as dental health care workers (DHW). Methods Through a combination of focus group interviews and individual interviews, data were collected from 63 participants; 30 patients in OMT and 33 DHW. Thematic analysis identified key themes for the use (or not) of oral health care services amongst patients in OMT. Results Both individual and structural barriers prevent OMT patients from using the free oral health care services offered to them. These barriers include struggling to attend appointments, anxiety and fear of dentists, discrepancies between patients’ expectations and the services offered and perceived stigma. OMT patients’ lack of information regarding their rights and access to oral health services was also a barrier, as was DHWs’ lack of knowledge and information of the OMT system and what they can offer patients. Conclusions OMT patients face several barriers in accessing and using oral health care services. However, through a number of relatively simple measures, it is possible that the use of oral health services amongst OMT patients can be increased.publishedVersio

Integrated treatment of hepatitis C virus infection among people who inject drugs:A multicenter randomized controlled trial (INTRO-HCV)

BackgroundThe standard pathways of testing and treatment for hepatitis C virus (HCV) infection in tertiary healthcare are not easily accessed by people who inject drugs (PWID). The aim of this study was to evaluate the efficacy of integrated treatment of chronic HCV infection among PWID.Methods and findingsINTRO-HCV is a multicenter, randomized controlled clinical trial. Participants recruited from opioid agonist therapy (OAT) and community care clinics in Norway over 2017 to 2019 were randomly 1:1 assigned to the 2 treatment approaches. Integrated treatment was delivered by multidisciplinary teams at opioid agonist treatment clinics or community care centers (CCCs) for people with substance use disorders. This included on-site testing for HCV, liver fibrosis assessment, counseling, treatment, and posttreatment follow-up. Standard treatment was delivered in hospital outpatient clinics. Oral direct-acting antiviral (DAA) medications were administered in both arms. The study was not completely blinded. The primary outcomes were time-to-treatment initiation and sustained virologic response (SVR), defined as undetectable HCV RNA 12 weeks after treatment completion, analyzed with intention to treat, and presented as hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals. Among 298 included participants, 150 were randomized to standard treatment, of which 116/150 (77%) initiated treatment, with 108/150 (72%) initiating within 1 year of referral. Among those 148 randomized to integrated care, 145/148 (98%) initiated treatment, with 141/148 (95%) initiating within 1 year of referral. The HR for the time to initiating treatment in the integrated arm was 2.2 (1.7 to 2.9) compared to standard treatment. SVR was confirmed in 123 (85% of initiated/83% of all) for integrated treatment compared to 96 (83% of initiated/64% of all) for the standard treatment (OR among treated: 1.5 [0.8 to 2.9], among all: 2.8 [1.6 to 4.8]). No severe adverse events were linked to the treatment.ConclusionsIntegrated treatment for HCV in PWID was superior to standard treatment in terms of time-to-treatment initiation, and subsequently, more people achieved SVR. Among those who initiated treatment, the SVR rates were comparable. Scaling up of integrated treatment models could be an important tool for elimination of HCV.Trial registrationClinicalTrials.gov.no NCT03155906

"Hun var jo bare en rusmisbruker." Stigmatisering av etterlatte etter narkotikarelaterte dødsfall.

Artikkelen belyser hvordan etterlatte ved narkotikarelaterte dødsfall opplever møtet med hjelpeapparatet, og hvordan fagfolk som møter de etterlatte, kan bidra til å øke eller minske den opplevde stigmatiseringen av dem. Bakgrunnen for artikkelener at det hvert år dør ca. 300 mennesker av overdoser og narkotikarelatert død i Norge. Bak tallene sitter mange sørgende etterlatte tilbake. Likevel mangler det generaliserbar kunnskap om hvilke konsekvenser narkotikarelatert død har for nære etterlatte, og hvordan de møtes av hjelpeapparatet. Studier fra andre former for unaturlig død viser at etterlatte ofte ikke får den hjelpen de trenger, dersom ikke hjelpeapparatet har en proaktiv og empatisk tilnærming til de rammede. Artikkelforfatterne er knyttet til prosjektet «Etterlatte ved narkotikarelatert død i et recoveryperspektiv» (END-prosjektet) ved Høgskulen på Vestlandet. Artikkelen er teoretisk med empiriske eksempler som bygger på forfatternes egenopplevelser som etterlatte, og klinisk arbeidserfaring. Erfaringene knyttes til teori om stigmatisering, sosial interaksjonisme og kommunikasjonsteori for å belyse hvordan samhandlingen kan fortone seg, sett fra et etterlattperspektiv. Artikkelen viser at stigmatisering kan prege samhandling og kommunikasjon mellom etterlatte ved narkotikarelatert død og ansatte i hjelpeapparatet, og kan legge stein til byrden for de etterlatte. Det er viktig med kunnskap om komplekse stigmatiseringsprosesser i hjelpeapparatet

Non-financial barriers in oral health care: a qualitative study of patients receiving opioid maintenance treatment and professionals’ experiences

Background People with substance use disorders often have poor oral health, which can negatively impact their quality of life. Since 2005, patients receiving opioid maintenance treatment (OMT) in Norway have been eligible for free oral health care services offered through public oral health clinics. Despite a large need for oral health services amongst patients in OMT, figures suggest that the use of these services is low amongst this patient group. It has been unclear which barriers that contribute to this. This qualitative study explores the underlying barriers to the use of oral health care services amongst patients in OMT, from the perspective of the patients as well as dental health care workers (DHW). Methods Through a combination of focus group interviews and individual interviews, data were collected from 63 participants; 30 patients in OMT and 33 DHW. Thematic analysis identified key themes for the use (or not) of oral health care services amongst patients in OMT. Results Both individual and structural barriers prevent OMT patients from using the free oral health care services offered to them. These barriers include struggling to attend appointments, anxiety and fear of dentists, discrepancies between patients’ expectations and the services offered and perceived stigma. OMT patients’ lack of information regarding their rights and access to oral health services was also a barrier, as was DHWs’ lack of knowledge and information of the OMT system and what they can offer patients. Conclusions OMT patients face several barriers in accessing and using oral health care services. However, through a number of relatively simple measures, it is possible that the use of oral health services amongst OMT patients can be increased

Peer involvement and cross-sector efforts in establishing integrated treatment of hepatitis C virus infection for people with substance use disorders: experiences from Norway

Background For people with opioid dependence in Norway, chronic hepatitis C virus (HCV) infections contribute to high mortality and high morbidity. Around 50% of patients in medically assisted rehabilitation (MAR) have been shown to have HCV, and the current prevention and control efforts have been mostly unsuccessful. Thus, there is a need for new strategies for people-centred service delivery and innovative methods to improve health outcomes. Methods Over the last few years, the city of Bergen, Norway, has developed a cross-sector collaboration with substantial peer involvement in research and health provision related to substance use. User group representatives for people receiving MAR, addiction medicine health personnel, infectious disease specialists, policy makers in the municipality, low-threshold health care centres for people with substance use disorders in Bergen Municipality and researchers in the INTRO-HCV project have made concerted efforts in this regard. We will present here some of the strategies and steps we have taken. Results We have established an integrated HCV treatment scheme for people who inject drugs or who have opioid dependence. More than 800 persons have been tested for HCV within these frames, and more than 250 persons have been given treatment for HCV within the project. The integrated treatment of HCV is offered both in MAR outpatient clinics, municipal low-threshold healthcare centres, and local and regional prisons. The preliminary results indicate an increase in HCV treatment uptake among those receiving integrated treatment (96% initiating treatment compared to 75%). The user group organisation ProLAR Nett has established an outreach service to screen for HCV, increase awareness and reduce the proportion of people unknowingly living with HCV while informing and motivating people to receive treatment. Together with the other stake holders, peer user group, health care, research planning, concert events, and policy panels have been held. Conclusions Peer involvement seems to have increased testing rates for HCV and acknowledgment of its importance. This seems to have improved health care for people with opioid dependence in Bergen over the last few years, particularly relating to the treatment of HCV. These experiences might be helpful in the planning of integrated policies in other settings that seek to eliminate the HCV endemic