Views, facilitators, barriers and strategies associated with detoxification in patients with opioid use disorder: A qualitative study on primary care general practitioners

Opioid Use Disorder (OUD) affects 16 million people worldwide and stems from the repeated use of opioids. Although standard care for OUD is based on harm reduction policy and relies on Opioid Maintenance Treatment, opioid detoxification still has some advantages over OMT. However, little is known about the medical community's views on this specific topic of the current advantages of detoxification. The objective of this study is to collect the views of GPs on detoxification and identify the facilitators, barriers and strategies associated with detoxification. We conducted a qualitative study using semi-structured in-person interviews with fifteen French GPs. After a triple-blind thematic analysis, main themes and sub-themes were selected after consensual agreement. We conducted an in-depth analysis of the discourse favouring an interdisciplinary approach. The main themes are: GPs' views on detoxification, facilitators, barriers and strategies associated with detoxification. Detoxification is seen through OMT tapering or inpatient detoxification. Facilitators of detoxification include a steady environment, sufficient motivation and trust. Barriers to detoxification include abuse of OMT, polydrug use, long periods of drug use and pregnancy. Alleged obstacles include lack of availability/knowledge and difficulty having access to specialised care. Strategies facilitating detoxification include a coordinated healthcare circuit involving multiple providers in a dedicated healthcare facility and the practice of physical activity. Detoxification is perceived through OMT tapering or inpatient detoxification. The conditions of practice influence the implementation of detoxification. This study shows that detoxification is possible in primary care in dedicated outpatient practices coordinated by GPs.