title: Enhancing motivation within a rapid opioid substitution treatment feasibility RCT: a nested qualitative study.
abstract: BACKGROUND
  Opioid substitution treatment (OST) has multiple benefits for heroin injectors and is an evidence-based major component of international treatment. The current qualitative study sought to explore participants' attitudes to and reasons for participating in a feasibility randomised trial in primary care offering 'same day' OST (methadone) for injecting heroin users compared to usual care.
  
  
  METHODS
  Twenty injecting heroin users (8 intervention and 12 controls; 16 males and 4 females) were interviewed; purposive sampling was used to select a maximum variation sample from those who agreed; and analysis used thematic methods.
  
  
  RESULTS
  Motivation to join the trial included the need to secure treatment set against some ambivalence due to previous negative experiences of trying to obtain OST. Positive effects of securing methadone via the trial, included self-reported improvements in health and self-care; reduction in crime, stress and drug use. Completing the baseline questionnaires at recruitment appeared to enhance motivation for treatment for all participants. For some control participants, this motivation seemed to increase a sense of self-efficacy and cognitive dissonance generated was resolved by seeking treatment from their GP. Self-determination theory suggests that behaviour change may have been initiated during the recruitment appointment, resulting in an increased determination to seek treatment amongst control participants.
  
  
  CONCLUSIONS
  Taking part in the 'script in a day' trial enabled participants in the intervention arm to gain same-day access to methadone and reduce their drug use. For those in the control arm, completing the baseline questionnaires at recruitment appeared to create cognitive dissonance between their current health state and own aspirations, so increasing motivation for treatment. Over 50% obtained and were still in receipt of OST (methadone or buprenorphine) at the 3 month follow-up. We suggest that a regular 'health evaluation' for injecting heroin users not in treatment, paired with low-barrier access to treatment, may be a way of exploring this and encouraging more into obtaining OST more quickly and at the best time for them. This intervention should be delivered without pressure for change.
  
  
  BACKGROUND
  This trial is registered with International Standard Randomised Controlled Trial Number Register: SCript In a Day for injecting drug users: feasibility trial: ISRCTN16846554.
authors.forename: Rachel
authors.initials: R
authors.lastname: Ayres
authors.affiliation: School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, UK. jenny.ingram@bristol.ac.uk.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ingram
authors.forename: Avril
authors.initials: A
authors.lastname: Rees
authors.forename: Jane
authors.initials: J
authors.lastname: Neale
authors.forename: Angela
authors.initials: A
authors.lastname: Beattie
authors.forename: Maggie
authors.initials: M
authors.lastname: Telfer
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use*; D003073:Cognitive Dissonance; D004739:England; D005240:Feasibility Studies; D005260:Female; D040261:Harm Reduction; D006556:Heroin Dependence / Q000188:drug therapy / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods / Q000523:psychology*; D017060:Patient Satisfaction; D015397:Program Evaluation; D036301:Qualitative Research; D015819:Substance Abuse, Intravenous / Q000188:drug therapy / Q000523:psychology / Q000534:rehabilitation*; D061665:Time-to-Treatment; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone