“Un attracteur de soins”: Bringing People Into Care. Interdisciplinary Health Care Professionals’ Attitudes Toward Opioid Agonist Therapy in France: a Qualitative Study with Implications for the United States

Abstract

Background:

Opioid agonist therapies (OAT), including methadone and buprenorphine, are first-line care in national and international guidelines, yet many countries, including the United States, frequently fail to effectively engage and retain people in OAT. How OAT is delivered—including the goals and culture of care—matters to patient engagement, treatment retention, and health outcomes. France has among the highest OAT receipt and lowest opioid-related morbidity and mortality worldwide. This study explored French interprofessional health care clinicians’ approach to OAT, drawing lessons to improve OAT implementation in the United States and elsewhere.

Methods:

We recruited interprofessional participants (eg, physicians, pharmacists, nurses, administrators) from diverse health care settings (eg, specialty addiction care, hospitals, public health) and regions and conducted in-depth semi-structured qualitative interviews. We conducted a reflexive thematic analysis using an inductive approach at a semantic level, identifying themes that held meaning to study participants and had implications for the United States and other contexts.

Results:

Twenty-one people participated. Participants described patient engagement as the primary goal of OAT, which has potential to draw people to care. They felt imposing or expecting abstinence was harmful and might obligate patients to lie or “lead a double life,” resulting in mistrust, missed care opportunities, and “losing patients” who disengaged from care. Participants described balancing flexibility and structure. They felt that flexibility promotes OAT access and engagement and that clinicians should contextualize decisions within patients’ risk environments, including those of an illicit drug supply and the black market. Participants described that structure should be offered as support, not punishment or control. Finally, they described that practices prioritizing engagement are sustained by policies and professional norms.

Conclusions:

Our findings challenge OAT practices and policies centered on abstinence and control. They suggest that approaches that prioritize patient engagement and balance flexibility and structure may be central to achieving high rates of OAT across a population.