Opioid-dependence treatment in the era of recovery: insights from a UK survey of physicians, patients and out-of-treatment opioid users

Background: Project Access UK was designed to provide real-world observations on the status of medication-assisted treatment (MAT) of opioid dependence. Methods: 544 respondents from three groups (physicians, patients in MAT and out-of-treatment users) were interviewed or completed questionnaires. Results: Patient reasons for seeking treatment included ending their dependence and improving their health and well-being. Patients and users reported a mean of 4.0 versus 2.7 prior MAT episodes, but patient awareness of the main treatment options varied from 94% for methadone to 46% for buprenorphine-naloxone. Among patients, 49% requested a specific medication (mostly methadone) and 78% of requests were granted. Forty percent of patients were not currently receiving psychosocial or key-working support. Daily supervised dosing was most commonly cited as a condition of staying in treatment with the biggest impact on daily life (36%). Among patients, 56% continued to use illicit drugs on top of their MAT and few (7%) were in employment. The majority of patients (56%) and users (51%) had been in prison (an average of 6.8 times). Conclusion: Patients are motivated to recover. However, the full range of evidence-based interventions are not fully utilised and many patients cycle repeatedly through periods of treatment, relapse and imprisonment.