STAGE 4. Selecting the theoretical approach

What steps should be completed?

Step 1: Select the theoretical approach or approaches on which the intervention will be based

OPIATE SUBSTITUTES MAINTENANCE PROGRAMMES

What are their bases?

Opiate Substitutes Maintenance Programmes (OSMP) are unique in being considered both treatment and cessation programmes for opiate dependence (to achieve abstinence) as a strategy for harm reduction. In response to the situation and the characteristics of the people treated, OSMP prioritise one of these two broad general objectives, which does not prevent some users being treated for both, or  interventions initially designed for harm reduction being reorientated to achieve abstinence.

What makes OSMP a harm reduction strategy is their positive impact on different areas related to the health and wellbeing of the people who benefit from them: reduced transmission of infectious diseases, acute reactions after use (overdose), mortality and criminal activities, and improved states of physical and mental health.

Maintenance programmes with opioid agonists are based on substitution of the opiate causing the dependence, usually heroin, by a legal opiate (methadone, buprenorphine) prescribed under medical control, for an extended period of time.

Practical implications

On a practical level, OSMP objectives may include the following:

• Eliminate or reduce objective and subjective symptoms of abstinence.
• Reduce illegal use of opiates and the use and dependence on other drugs.
• Reduce or eliminate practices that are hazardous for individual and public health and are associated with drug use (using the parenteral route, sharing syringes or other consumable materials, high-risk sexual practices, etc.).
• Improve physical and mental health (control the associated psychiatric and organic pathology, etc.).
• Reduce antisocial behaviour, increase social support and improve psychosocial functioning (including skills in securing and retaining employment).
• Encourage recruitment and retention of people in the treatment programme so that they might be susceptible to other types of interventions.
• Reduce harm linked to illicit opiate use (overdose, death, transmission of infectious diseases, etc.).