The effectiveness of methadone maintenance provision

Introduction and Aims; A qualitative study was carried out among a number of community drug projects in west Dublin. The projects in the course of their work support individuals that are accessing methadone maintenance treatment (MMT). The study aimed to gain an insight into the experience of service users as they negotiate MMT provision. This research focused in particular, on client’s initial goals as they accessed MMT, the important motivation factors driving their treatment decisions and the study considered the opportunities service users had to engage in self-directed change within the context of service provision. Design and Methods; The case study focused on person centred practice within a number of frontline community drug programmes in west Dublin. Nine participants were interviewed, all of whom in the course of their work engage professionally with MMT service users. Research was conducted using semi-structured interviews which were informal and openended and set out to discover some of the embedded elements within drug service delivery which have direct impact on service user progression. Participation in the study was voluntary and anonymous. Results; The general findings from this research were that MMT service users primarily are seeking to introduce a level of stability into their lives when they first present for treatment. The decision to access treatment is largely motivated by matters relating to their immediate family. In the majority of cases service users state that their long term goal is to be drug free. The clinic environment and difficulties encountered establishing a shared and equal relationship with clinic staff, GPs and pharmacies, were identified as the major barriers to client progression. Discussion and Conclusions; It was accepted that many elements of MMT provision worked successfully and that both clinic staff and GPs were in many cases willing to engage meaningfully with service users and key workers. However many elements were highlighted within service provision which serve to obstruct the purposeful engagement of service users. The study suggests that in order for MMT to develop into a more effective service, formal measures which promote the service user as a partner to other stakeholders, need to be integrated into provision.