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Background: Heroin-assisted treatment (HAT) is an evidence-based treatment option for opioid use disorder (OUD), available in a limited number of countries. Norway implemented a 5-year HAT project in 2022, aiming to assess its effectiveness and its potential integration into the country's OUD treatment system. This study describes and compares patients' baseline characteristics from the Oslo and Bergen HAT clinics, providing a comprehensive picture of the unique population and the real-world application of HAT., Methods: This cross-sectional study examines the baseline characteristics of consenting HAT patients within the first 2 years of operation ( n  = 86). Self-reported questionnaires gathered sociodemographics, previous treatment experiences, self-reported crime, and substance use, as well as motivations and expectations for treatment. Comparisons between the clinics were carried out using t -tests, Mann-Whitney U tests, Chi-square, and Fisher's exact test., Results: The majority of the patients were enrolled at the Oslo clinic (76%) and were male (80%). At admission, the average age was 45.9, with a significantly younger group in Bergen (42.5 vs 47.3, P  < .05). While no patients reported being unhoused, 17% noted unstable housing within the preceding month. Unemployment was prevalent (91%) alongside previous treatment experiences (95%), with a median of 2 prior medication types. In the 3 months preceding HAT initiation, 78% of patients reported being victims of crime, and 44% committed at least one crime. Over their lifetime, 2 in 5 participants (41%) had experienced an unwanted overdose and 43% had shared syringes and equipment., Conclusion: This study reveals a cohort experiencing societal marginalization, including unstable housing, unsatisfactory prior OUD treatment, high-risk behaviors, and frequent interactions with criminal activities, predominantly as victims. While the Oslo and Bergen clinics serve a similar patient profile, notable differences emerged in the reasons for discontinuing past OUD treatment and crime-related factors., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Little attention has been paid to the experiences of clinicians and health personnel who provide heroin-assisted treatment (HAT). This study provides the first empirical findings about the clinicians' experiences of providing HAT in the Norwegian context., Methods: 23 qualitative interviews were conducted with 31 clinicians shortly after HAT clinics opened in Norway's two largest cities: Oslo and Bergen. By inductive thematic analysis of interview transcripts, we identified what research participants experienced and viewed as the chief rewards and challenges of providing HAT. The study aimed to offer an overview of these key rewards and challenges, with insights potentially transferable to HAT programs internationally., Results: Participants experienced three aspects of providing HAT as particularly rewarding, and three as most challenging. The rewarding aspects were observing harm reduction outcomes; providing holistic care; and having a positive clinic milieu and patient-clinician relationships. The challenging aspects were dosing and overdose risk; rule enforcement and aggression management; and the difficulty of initiating treatments beyond medication and harm reduction. The rewarding and challenging aspects of providing HAT overlapped and were at times contradictory, thus reflecting the duality and tensions in clinicians' work to provide HAT. The challenges were reported to vary between patient subgroups, according to their degree of instability. The most unstable patients were seen as involving more difficulties as regards the challenging aspects of HAT. Participants expressed uncertainty about HAT's utility for a small group of the most unstable patients., Conclusion: While studies about clinical experiences of HAT have usually examined individual or limited aspects of treatment provision, this study provided an overview of the main aspects of the rewards and challenges of providing HAT. Importantly, it also showed the tensions between these overlapping and sometimes contradictory aspects of HAT provision. Because a positive patient-clinician relationship is crucial to patient satisfaction and treatment outcomes in HAT, the provision of training for clinicians on navigating the inherent tensions of HAT provision, nurturing therapeutic alliances with patients, and managing their role as gatekeepers to medical heroin and valuable services, seem particularly important for ensuring that care is patient-centered and staff are adequately supported., Competing Interests: Declarations. Ethics approval and consent to participate: The project was approved by the Regional Ethical Committee (195733) as well as the local Data Protection Officers in Bergen Health Trust (3061–3061) and Oslo University Hospital (20/27594). Written informed consent was obtained from the participants prior to the study procedures. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Opioid agonist treatment (OAT) for patients with opioid use disorder (OUD) has a convincing evidence base, although variable retention rates suggest that it may not be beneficial for all. One of the options to include more patients is the introduction of heroin-assisted treatment (HAT), which involves the prescribing of pharmaceutical heroin in a clinical supervised setting. Clinical trials suggest that HAT positively affects illicit drug use, criminal behavior, quality of life, and health. The results are less clear for longer-term outcomes such as mortality, level of function and social integration. This protocol describes a longitudinal evaluation of the introduction of HAT into the OAT services in Norway over a 5-year period. The main aim of the project is to study the individual, organizational and societal effects of implementing HAT in the specialized healthcare services for OUD., Methods: The project adopts a multidisciplinary approach, where the primary cohort for analysis will consist of approximately 250 patients in Norway, observed during the period of 2022-2026. Cohorts for comparative analysis will include all HAT-patients in Denmark from 2010 to 2022 (N = 500) and all Norwegian patients in conventional OAT (N = 8300). Data comes from individual in-depth and semi-structured interviews, self-report questionnaires, clinical records, and national registries, collected at several time points throughout patients' courses of treatment. Qualitative analyses will use a flexible inductive thematic approach. Quantitative analyses will employ a wide array of methods including bi-variate parametric and non-parametric tests, and various forms of multivariate modeling., Discussion: The project's primary strength lies in its comprehensive and longitudinal approach. It has the potential to reveal new insights on whether pharmaceutical heroin should be an integral part of integrated conventional OAT services to individually tailor treatments for patients with OUD. This could affect considerations about drug treatment even beyond HAT-specific topics, where an expanded understanding of why some do not succeed with conventional OAT will strengthen the knowledge base for drug treatment in general. Results will be disseminated to the scientific community, clinicians, and policy makers., Trial Registration: The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (REK), ref.nr.:195733., (© 2024. The Author(s).)