Brioude

Researchers are evaluating a new approach to methadone treatment for people with opioid use disorder (OUD) in France. This study focuses on the role of nurses in specialized addiction centers, called CSAPA, where methadone treatment usually starts under hospital doctor supervision. The research aims to see if allowing nurses to manage methadone initiation more independently, following a standardized protocol, can improve patient retention in care during the first three months after treatment begins. The study compares two strategies: the DIADEME strategy, where nurses adjust methadone doses weekly based on clinical assessments and follow a specific protocol including initial medical consultation and testing, versus the control strategy which follows the standard practice with hospital doctors leading care supported by nurses. Methadone syrup is mainly used for initiation, with prescriptions renewed every 14 days. Follow-up visits with nurses occur at least weekly, and doctors are consulted only if serious issues arise or at patient request. Additional interviews with patients and healthcare professionals will explore experiences and impacts of the intervention. Participants will be followed for three months, with regular consultations and clinical monitoring including ECG and tests for infections. Researchers will assess patient retention in care as the primary outcome. Semi-structured interviews will also be conducted one month after follow-up ends to understand patient commitment, satisfaction, and effects on healthcare teams. The study involves adults starting methadone treatment for OUD at CSAPA centers and tracks their progress and adherence to care over time.