Abstract
Many people around the world will engage in the recreational use of a substance, such as alcohol, cannabis, or opioids. While many may not experience serious negative consequences of such use, others may develop substance use disorders, including opioid use disorder (OUD). OUD is a serious and chronic condition that is associated with various negative outcomes (Strang et al., 2020). For those with OUD who are seeking treatment, one of the most common and effective options available is opioid substitution treatment (OST; Bell & Strang, 2020).
Despite other positive outcomes, people receiving OST continue to demonstrate worse cognitive functioning relative to healthy controls in various cognitive domains (Baldacchino et al., 2017). However, most prior research examines objective cognitive functioning and does not attempt to understand cognitive functioning from the perspective of the individual. In other populations, having subjective cognitive impairment is associated with various negative outcomes such as a worse quality of life (Hill et al., 2017). There is also a lack of research in the area from an Aotearoa New Zealand perspective.
Thus, the present research aimed to (1) investigate perceptions of cognitive impairment and its impact on general functioning in people receiving OST using qualitative methods, and (2) make particular effort to engage Māori tāngata whaiora (people seeking health), who may have unique interpretations of cognitive impairment compared with non-Māori participants.
To address these research aims, 13 semi-structured qualitative interviews were conducted. The participants were seven men and five women, ranging in age from 23-67, of various ethnicities (New Zealand European/Pākehā, Māori, Pasifika, South American, and other European), and receiving OST (eight receiving methadone, five receiving buprenorphine/naloxone) in Ōtautahi Christchurch.
To participate, individuals were required to self-report problems with cognitive functioning. During interviews, participants were asked questions including about how they perceived their own cognitive ability, the types of cognitive problems they experienced, what they think causes such problems, and their potential impacts on daily living.
Five themes were developed and refined from participants’ transcripts through thematic analysis: (1) not at peak, (2) silver linings, (3) annoying and embarrassing, (4) compensating and (5) optimising. Participants reported that their cognitive functioning had become worse over time (Theme 1). Although OST was seen to have some negative effects on cognitive functioning, it was also seen to improve other aspects of cognitive functioning, and to improve wider functioning in general (Theme 2).
Experiencing problems with cognitive functioning was generally viewed negatively (Theme 3). Participants attempted to minimise the impact of their experienced cognitive problems by either using compensatory strategies, such as writing things down (Theme 4), or otherwise trying to optimise their cognitive functioning; for example, by engaging in brain games or working on their wider wellbeing (Theme 5). The themes are situated in the wider context of OUD and OST, where stigma and other negative consequences remain pervasive.
Overall, the present study sheds light on how participants receiving OST perceive and manage problems with their cognitive functioning. More awareness is needed about this important but often overlooked issue, and future research should consider interventions to help those experiencing such problems more effectively manage them.