| dc.description.abstract | Background. Opioid dependence is a chronic and relapsing condition and the majority of opioid dependent individuals benefit from long term opioid maintenance treatment. However, for a smaller but significant portion of this group, this treatment has not been satisfactory and has not led to long term gains. For severely dependent individuals with previous treatment experience, heroin-assisted treatment (HAT) is a safe and effective therapeutic alternative. Since April 2010, HAT has been available in Denmark. Objective. The aim of this thesis is to examine heroin-assisted treatment in Denmark on three different aspects. First, the characteristics of the treatment population entering HAT are explored. Second, factors at inclusion associated with retention in treatment are examined. Third, changes in crime rates and healthcare utilization between two time periods are investigated. Methods. This is a registry-based observational study, which includes a national cohort of patients admitted to HAT in Denmark between 2010 and 2016. A multivariate Cox regression model is used to investigate factors associated with treatment drop-out. Crime and healthcare utilization are measured as a yearly rate in two periods of time: the year previous treatment entrance and the period from the date of admission to the end of the observed period (November 2017). The rates are compared using the sign test of matched pairs. Findings. At admission patients record instability in different aspects of life: employment, housing, treatment experiences, past health needs and criminal history. Retention in treatment is positively associated with older age, being female, injecting as route of administration and stable housing. In the period in which patients experience HAT compared to the year previous treatment admission, a statistically significant reduction in convictions and emergency health services is measured. Preliminary results of this study suggest that heroinassisted treatment has a positive impact in stabilizing the patients. | eng |