Tim Bingham

A qualitative study of prescribing doctor experiences of methadone maintenance treatment.

Methadone maintenance treatment [MMT] is recognized as an effective treatment for opiate dependence. It is provided in Ireland in addiction clinics and for stabilized patients in primary care. The aim of the study was to explore doctor’s experiences of methadone prescribing, therapeutic alliance and methadone treatment pathways. Semi structured interviews were conducted with a convenience sample of prescribing doctors (n = 16). Thematic analysis of narratives was undertaken. Observations around MMT were positive in reducing harm associated with injecting drug use and opiate dependence, and represented an important turning point for patients. Doctor efforts to assist their patients were grounded in positive, empathic relationships. Some concerns were relayed with regard to prescribing restrictions. Participants commented on the need for policy makers to consider the expansion of MMT provision to include alternative pharmacological approaches, improved interagency, psychosocial and detoxification supports, community based nurse prescribing and adjunct treatment for poly drug and alcohol use.

Open Drug Scenes and Drug-Related Public Nuisance: A Visual Rapid Assessment Research Study in Dublin, Ireland

The research was undertaken at a time of increasing public concerns for drug- and alcohol-related public nuisance in the city center of Dublin, Ireland. Rapid Assessment Research was conducted involving qualitative interviewing with drug service users; business, transport, community, voluntary, and statutory stakeholders (n = 61); and an environmental mapping exercise. The interplay between homelessness, loitering, an influx of drug users via city metro systems, transient open drug scenes, street drinking, drug injecting, intimidation, knife crime, and prescribed medication abuse was evident. Potential strategies to address drug and alcohol related public nuisance are advised to include the relocation of treatment services, targeted harm reduction initiatives, urban regeneration, improved community rehabilitation pathways, and heightened policing intensity.

Service stakeholders' perspectives on methadone maintenance treatment, Special Community Employment schemes and client recovery pathways.

BACKGROUND: Previous Irish research on client perspectives on the ‘lived social world’ of methadone maintenance treatment (MMT) and participation in Special Community Employment (SCE) schemes have illustrated how MMT offers clients the opportunity to commence recovery and community reintegration, with participation in the SCE schemes acting primarily as therapeutic support mechanism with improvement needed in work based support and employment related outcomes. OBJECTIVES: The research aimed to explore service providers’ views on MMT client experiences of participation in SCE vocational training, education and employment seeking. METHODS: Five in depth interviews and three focus groups (n = 14) were conducted with key specialist treatment and rehabilitation service providers’ in Dublin, Ireland. RESULTS: Narratives were thematically analysed, and indicative of the positive role of MMT in recovery pathways in terms of stimulating initial client stabilisation, reducing client chaotic lifestyles, initiating new positive health and social behaviours with partners, children, families, and facilitating renewed vocational training on SCE schemes. Outcomes whilst positive in terms of personal development when in recovery are compromised by lack of employment prospects and dedicated work-based supports on exit. CONCLUSIONS: Recommendations were made around the need for long term integrated community care, vocational certification, supported volunteer, employment planning and back to work schemes.