Brioude

Researchers are evaluating a new approach for starting methadone treatment in people with opioid use disorder OUD in France. This study focuses on whether allowing nurses in specialized addiction centers CSAPA to manage methadone dosing independently can improve patients adherence and retention in care compared to standard hospital doctor-led management. The study aims to clarify the essential nursing skills needed for this semi-autonomous methadone delivery system and its impact on treatment outcomes. Participants will be randomly assigned to one of two groups. The experimental DIADEME group follows a standardized protocol enabling nurses to adjust methadone doses based on clinical assessments of opioid withdrawal and overdose risk, with doctors involved only for major issues or patient requests. The control group receives usual care with methadone initiation and management led by hospital doctors assisted by nurses. The study also includes focus groups with healthcare professionals to evaluate the interventions effects on care practices. Participants will be followed for three months, with regular assessments including methadone dosing, opioid withdrawal symptoms, overdose episodes, hospital admissions, and various health questionnaires on quality of life, satisfaction, depression, anxiety, and substance use. Nurses will monitor patients weekly or more often if needed, and doctors will intervene as necessary. The primary outcome is patient retention in care at three months. Additional interviews with patients and professionals will explore experiences and acceptability of the new care model.