LAUSR

The technology for delivering opioid pharmacotherapy (OPT) is expanding. It is important to know what OPT patients think of these developments and to find ways of enabling patients and clinicians to make informed decisions about which biodelivery system to choose. We explored the views of current and former OPT patients with a history of heroin use to identify factors influencing their preferences regarding routes of OPT administration. Data were generated via seven focus groups conducted in London, United Kingdom. Participants (n = 44) considered standard biodelivery systems (liquid/linctus, tablet, injectables), emergent systems (implants, depot injections), and a hypothetical system (nasal sprays). Groups were audio-recorded, transcribed verbatim, coded using qualitative software, and analyzed inductively via iterative categorization. Participants were cautious of, but willing to consider, new ways of receiving OPT and they welcomed having more choice. Their preferences and decision-making processes were influenced by nine interconnected factors: (a) personal dislike of particular biodelivery systems, (b) desired feelings following OPT administration, (c) perceived effectiveness of OPT biodelivery systems, (d) concerns about side effects, (e) ability to control the OPT, (f) impact on daily lives, (g) concerns about OPT-related stigma, (h) need for psychosocial support, and (i) personal treatment goals. This complexity may make it difficult for patients and clinicians to evaluate the pros and cons of the expanding array of OPT biodelivery systems and to arrive at clear conclusions. We therefore use the findings to construct a checklist that may facilitate discussions with patients when decisions about OPT need to be made.