Pathways Traversed by Patients with Opioid Dependence Syndrome in two Settings: An Exploratory Study

Abstract

Background: There is limited published literature from India on pathways traversed by patients with opioid dependence syndrome (ODS). The study was carried out in north Indian UT, tertiary care hospital and its attached community outreach centre. Aims: The current study was conducted to assess and compare paths traversed by patients with opioid dependence syndrome (ODS) in two settings. Settings and Design: It was a cross-sectional and exploratory study conducted at two different treatment settings i.e.De-addiction Clinic (DAC) in hospital and Community Outreach Clinic (COC). Materials and Methods: A total sample of 100 consecutive male patients with ODS as per ICD-10 were enrolled from DAC of tertiary care teaching hospital of North India and COC. Socio-demographic and clinical details of the clinical sample were collected on semi-structured proforma and the pathways to care were assessed through a specifically designed questionnaire. Statistical Analysis: Data was analyzed using licensed SPSS (version 20.0). The Kolmogorov-Smirnov test (Lilliefors Significance Criterion) was used to determine the normality of the data. Chi square test was used to compare the variables on socio-demographic data and clinical profile of patients of both the groups. Results: Mean age of the OPD sample was 29.94±8.89 while mean age of community sample was 32.38±9.94 years.  Majority of DAC patients (54%) used semi-synthetic form of opiate while 44% of COC sample used the natural form of opioid (p = 0.022). However only 42% of DAC patients had sought treatment in past while 22% of COC patients had past history of treatment (p = 0.032). In the DAC group, 20% patients directly sought treatment from DAC, while 74% of the patients at COC sought help for the very first time directly. None of the patients in either group went to faith healers. Additionally, patients with lower income, lower education and using natural opiates with longer duration of dependence and earlier age of onset prefer COC services. Conclusion: This study found out that more than 2/3^rd of patients in the COC directly sought treatment for the first time from COC depicting shorter pathways traversed against 1/5^th of DAC sample.