Hydromorphone Hopes: A Qualitative Study of People Initiating Supervised Short-Acting Injectable Opioid Treatment in Australia.

Background: A growing body of qualitative scholarship has drawn attention to aspects of supervised injectable opioid treatment (SIOT) not captured in earlier clinical trial data, identifying treatment initiation as one such area. Crucial questions surrounding people's motivations, expectations and initial experiences of SIOT remain under-explored. This paper examines the first tranche of qualitative findings from participants of Australia's first-ever SIOT trial, the 'Feasibility of Opioid Injectable Treatment' (FOpIT) study. Noting the novelty of both SIOT and hydromorphone within the Australian context, we ask: what motivated people to participate in the trial and what were their early experiences of this new treatment and medication?

Methods: Fifteen semi-structured, in-depth qualitative interviews were conducted with participants commencing hydromorphone.

Results: Almost universally, participants expressed a strong desire for change in their lives, foregrounding their intention to cease or reduce their use of street heroin. For many, the appeal of SIOT was driven by prior, unsatisfactory experiences with standard opioid agonist treatment (methadone, buprenorphine). Early accounts of hydromorphone ranged from favourable comparisons to street heroin to noting its relative shortcomings. Nonetheless, a dominant narrative emerged of reduced or ceased use of street heroin within days of beginning the trial.

Conclusions: Understanding the complexities surrounding SIOT initiation has clear implications for clinical practice, including the potential for improved treatment engagement, retention and outcomes. Accounts from FOpIT participants commencing SIOT revealed a diversity of motivations, hopes, goals and medication effects. The extent to which these are carried through to treatment outcomes is an area of ongoing research.