Changes in quality of life (WHO-QOLBREF) and addiction severity index (ASI) among participants in opiate substitution programs in low and middle income countries: An international systematic review

Background: Opiate Substitution Treatment (OST) can increase quality of life (WHO-QOLBREF) and reduce addiction severity (ASI) among participants. Program participants in several studies have noted that improvements in quality of life is one of the most important factors to their reduction in drug use and associated risky behavior. However, there is little systematic understanding of WHO-QOLBREF and ASI domain changes, over time, among OST participants in low and middle-income countries (LMIC), where programs have only been recently implemented.

Methods: Utilizing PRISMA guidelines we conducted a systematic literature search to identify OST program studies that documented changes in WHO-QOLBREF or ASI domains for participants in buprenorphine or methadone programs in LMIC. Mean baseline and follow-up domain scores were calculated and compared along with relationships between domain scores, OST dosage, and treatment follow-up period.

Results: There were 13 OST program studies with 1801 participants eligible for inclusion in the review from China, Lithuania, Malaysia, Taiwan, Thailand, Vietnam, and Ukraine. Mean WHO-QOLBREF domain scores improved and mean ASI domain scores were reduced and changes were statistically significant for ASI psychological (p=0.04), family (p=0.09), and legal (p=0.03) domain scores.

Conclusion: WHO-QOLBREF and ASI are useful tools for measuring overall health, quality of life and levels of addiction among OST participants. Coupled with measurements of blood borne infection, drug use, relapse, and overdose, WHO-QOLBREF and ASI represent complimentary but equally important tools for measuring OST participants over time and should be further developed as evaluation tools in emerging programs in LMIC.