Comparative study between prison- and community-based treatment satisfaction for opioid use disorder in Lebanon

• Pages: 138-152
• DOI: https://doi.org/10.1108/IJPH-12-2017-0064
• Date: 10 June 2019
• Published date: 10 June 2019
• Author: Dany Khalaf,Maryse Hayek,Jules-Joel Bakhos,Fadi Abou-Mrad
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Comparative study between prison- and

community-based treatment satisfaction

for opioid use disorder in Lebanon

Dany Khalaf, Maryse Hayek, Jules-Joel Bakhos and Fadi Abou-Mrad

Abstract

Purpose –Opioid substitution treatment (OST), such as Buprenorphine, has become a well-established

evidence-basedapproach for thetreatment of inmates with opioiduse disorder (OUD) in most of the developed

world. However,its application in Lebanonremains mainly as a community-based intervention.The purpose of

this paper is to highl ight the need of its implementation wit hin the Lebanese correctional syste m.

Design/methodology/approach –The work is a pilot cross-sectional study that compares two groups:

30 male adult prisoners with OUD convictions receiving symptomatic treatment and 30 male adult

community patients with OUD receiving Buprenorphine. The objective was to measure the difference in the

patients’general perception and satisfaction of the treatments available. OUD was diagnosed using the

Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria and the level of satisfaction was

measured by “Treatment Perceptions Questionnaire (TPQ).”

Findings –The prison group reported significantly lower satisfaction when compared to the community

group (total TPQ mean scores: M ¼34.73, SD ¼4.12 and M ¼16.67, SD ¼4.78, respectively, with t (56.76)

¼15.68, p ¼0.000). Furthermore, age, marital status, education level and elapsed time in treatment had no

significant interactions with the total TPQ score.

Originality/value –The major principles of the ethics of care and evidence-based safe practices will be

proposed for the introduction of Buprenorphine to Lebanese prisons. This work provides an opportunity for

the expansion of the Lebanese OST program and consequently other countries in the region could benefit

from this experience.

Keywords Patient satisfaction, Lebanon, Prisons, Harm reduction, Buprenorphine, Opioid substitution

Paper type Research paper

Introduction

Opioid use disorder (OUD) and up-to-date management

OUD mainly comprises heroin or any analgesic with an opiate component. It has been

consistently recognized as a neurobiological disorder, with recent clinical neuropsychological

studies focusing on advanced neuroimaging to uncover its complex nature and relapsing

mechanisms (Ieong and Yuan, 2017).

Simple detoxification, with or without post-cure residential rehabilitation, remains the initial

treatment approach in several countries (Mathers et al., 2010) including Lebanon. However,

medication assisted therapy, allowing patients to function normally once stabilized on an

adequate dose (WHO et al., 2004), is becoming more prominent as a treatment option for OUD

detoxification and maintenance (Stotts et al., 2009). Moreover, opioid substitution therapy (OST),

such as Buprenorphine among others, has shown to be an effective evidence-based method for

managing OUD with a positive safety profile (Connery, 2015; Wu and Clark, 2013).

Buprenorphineis a semi-synthetic μ-opioid partialagonist with weak partial agonisteffects at both

Δand κopioidreceptors. In 2002, it was approved by the US Foodand Drug Administration (FDA)

Received 27 December 2017

Revised 14 June 2018

Accepted 13 August 2018

Conflict of interest and funding:

there is no conflict of interest to be

mentioned and this research did

not receive any specific grant from

funding agencies in the public,

commercial or not-for-profit

sectors. The authors would like to

thank all the staff and patients at

Roumieh prison and AJEM NGO

for their participation and help in

this research without whom it

would not have been made

possible. Their contribution, time

and effort were highly valuable.

The authors are sincerely grateful

to the former General Director of

the Lebanese Internal Security

Forces, Major General Ibrahim

BASBOUS; the current General

Director of the Lebanese Internal

Security Forces, Major General

Imad OTHMAN; the Head of the

polyclinic at Roumieh prison,

Colonel Habib El TAKACH; the

Head of Public Relations

Department of the Lebanese

Internal Security Forces, Colonel

Joseph MOUSSALLEM; and the

Head of AJEM NGO, Father Najib

Baaklini whose understanding,

encouragement, generous

guidance and cooperation through

the course of this study made this

work possible and successful.

Finally, this work has been inspired

and done in memory of late Father

Hady El AYA, founder and former

Head of AJEM NGO.

(Information about the authors

can be found at the end of this

article.)

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VOL. 15 NO. 2 2019, pp. 138-152, © Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-12-2017-0064