An Investigation on the Guideline Adherence in Opioid Addiction Treatment and the Causes of Nonadherences

Objectives: This study was aimed to evaluate the level of adherence to the World Health Organization and American Society of Addiction Medicine guidelines regarding opioids addiction medications and to identify the causes of nonadherence, in Hamadan. Materials and Methods: The patients' records were used to obtain data on the patients' demographics and treatment process. The adherence to the mentioned guidelines was evaluated and reasons for nonadherence were asked from physicians. Results: At the time of the study, methadone maintenance treatment (MMT) and buprenorphine maintenance treatment (BMT) were the only common opioid addiction treatments in Hamadan. The number of the cases in BMT and MMT group was 18 and 142, respectively. The rate of the treatment course accomplishment (passing 4 stages) was 4.2% for MMT and 0% for BMT. In the induction phase, the adherence rates regarding initial dosing and regular weekly visits were 66.7 and 27.8% for BMT, beside 27.5, and 60.6% for MMT. Concerning the stabilization stage, the dosage amount, dose modification, and regular visits, respectively, 41.5%, 24.6%, and 27.5% of MMT cases were performed in adherence to the guidelines, whereas adherence of dose selection for BMT was 11.1%. In the MMT elimination stage, 33.3% compliance was observed; no case of BMT had continued the treatment to this stage. No discrepancy was because of the physicians' disbelief in clinical guidelines; they were either aimed to tailor the treatment with a patient's condition or resulted from familial, sociocultural, and financial problems. Conclusions: Overall, enhancement of patients and their families' awareness about medication process appears necessary.