Providers' perspectives on what heroin-assisted treatment ought to be: a qualitative study

Heroin-assisted treatment (HAT) is an option for opioid use disorder (OUD), particularly for individuals not adequately served by standard therapies like methadone. Studies indicate that HAT can reduce criminal activity and enhance integration into society, as evidenced by significant long-term benefits in employment and health outcomes for marginalised populations. The Norwegian HAT program, launched in 2022, aims to complement existing opioid agonist treatments and improve health outcomes for those with OUD. This study seeks to explore clinicians' perspectives on the ideal structure of HAT and identify challenges that may affect its implementation.

This qualitative study employed an explorative design, conducting 21 semi-structured individual interviews with clinicians from the Norwegian HAT, including one interview with two clinicians. Individual interviews were chosen to facilitate open discussions about their experiences and views on HAT. Analysis was performed using Braun and Clarke's reflexive thematic analysis framework to identify key themes and patterns from the transcripts.

Four overarching themes were identified, whereof the first three were interrelated. The themes reflect clinicians' ideal treatment philosophy and perspectives on what heroin assisted treatment ought to be: (1) An individualised and patient-centred treatment, (2) A holistic approach with an interdisciplinary collaboration, (3) A flexible service, and (4) Incorporating substance use as a reality.

The clinicians' insights outlined a comprehensive vision of HAT grounded in the principles of individualisation, holistic care, flexibility, and a realistic understanding of substance use. They found it essential to integrate medical, psychological, and social support while fostering collaboration among healthcare professionals. This framework not only responds to the complex realities of addiction but may also support pathways toward recovery, according to clinicians. These insights indicate a need for policy changes within the Norwegian HAT and resources that empower comprehensive care strategies within opioid agonist treatment frameworks.