This thesis, in addiction medicine, investigated staff attitudes towards opioid maintenance treatment (OMT) in different settings, and their association with treatment differences within the Norwegian OMT programme. In New South Wales, Australian prison health staff were found to discourage inmates from entering or remaining in OMT. Thus, the first aim of this thesis was to investigate staff attitudes towards and knowledge of OMT among prison health staff. In Norway, annual assessments of the Norwegian OMT programme had identified treatment differences between the 14 regional OMT centres since 2004. There were some indications that these differences were associated with staff attitudes. The second aim of this thesis was to cross-culturally adapt the instrument used among Australian prison health staff into Norwegian and to assess Norwegian staff attitudes towards OMT. It also explored treatment differences within the Norwegian OMT programme and their possible associations with attitudes.
The three studies had cross-sectional designs. The prison health staff study (n=396) was conducted in 2003 in NSW, Australia. The Norwegian attitudinal staff study was undertaken in 2007 in Oslo among 140 OMT staff and 180 harm reduction staff. The assessment of the Norwegian OMT programme used aggregated data from the annual OMT assessments from November 2007 and 2008.
Australian prison health staff with little knowledge of methadone treatment were more likely to be abstinence-oriented. These staff were more likely to encourage inmates to leave the OMT programme prior to release from prison. In the Norwegian staff study there were differences between the regional OMT in attitudes towards OMT. Centres that were more likely to support discharge from treatment due to drug use and advocate limitations on who should have access to OMT had smaller caseloads, more frequent urine drug screening and increased case management. In addition less of their patients used drugs previous four weeks and more patients had long-term housing facilities and employment. These studies show that staff attitudes towards OMT are important factors that may influence treatment in many ways.
List of papers
Paper I and III are removed due to copyright restrictions.
I Gjersing LR, Butler T, Caplehorn JR, Belcher JM, Matthews R. Attitudes and beliefs towards methadone maintenance treatment among Australian prison health staff. Drug & Alcohol Review 2007, 26:501-508.
II Gjersing LR, Caplehorn RM, Clausen T. Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Medical Research Methodology 2010, 10:13 (10 February 2010)
III Gjersing LR, Waal H, Røslien J, Gossop M, Clausen T. Differences in treatment practices and outcomes within a national opioid maintenance treatment programme. Submitted
IV Gjersing LR, Waal H, Caplehorn JRM, Gossop M, Clausen T. Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment. BMC Health Services Research 2010, 10:194 (6 July 2010)