Lung Health in a history of people with opiate use (LHOP)

Breathing problems may occur directly due to heroin (opiate) misuse (depressed breathing rate, asthma attack) but doctors have also reported that the common co-use of other drugs (cigarettes, cannabis, crack cocaine) increases the risk of developing chronic lung disease. There has been little research investigating these risks in patients with a history of opiate misuse who may, due to the nature of their significant psychosocial and health problems, be hard to recruit and retain in clinical studies over time. 

The research doctor will attend an established community substance misuse clinic to discuss the study with patients who have been given written information about the study by their clinicians and who have consented to be approached. Following face to face informed consent by the research doctor, she will administer semi-structured questionnaires to patients, to find out about their respiratory health and any relevant prescribed treatment. A spirometer test will be offered to measure lung function and feedback and explain the results to them, and with their consent, their general practitioners. The researchers will also ask about whether the study is an important area of health for them and whether this is a reasonable way to approach and recruit similar patients to future studies. The participants will be offered a £10 voucher for their time. The data derived from the questionnaires will be entered into an anonymised data base.

Findings will be discussed with clinicians and service users in a clinical meeting, in order to embed consumer participation from the outset in an application for a grant for a large multi-centre cohort study (cohort and/or intervention study) for which this pilot stage is essential. In addition this will strengthen the researchers' grant application with an estimate of recruitment rates and feedback about choice and feasibility of administration of questionnaires.

People with opiate addiction not only have poor lung health (due to the damaging effects of smoking drugs) but also struggle to attend regular health care appointments. 

We have initialed a number of studies to investigate this issue

1. A study screening people with opiate addiction for lung disease in a community substance use treatment clinic (plus literature review on poor lung health and opiate misuse). The majority (79%) of those screened had signs of undiagnosed serious lung disease. Screening was found to be acceptable in the community setting. These findings are being used to inform service re-design in Sheffield.

  • Findings have been fed back to the ‘Respiratory Health and Substance Misuse’ working group (with Sheffield Drug and Alcohol Coordination Team)
  • Sheffield substance use services are now undertaking a lung disease audit – a survey to service users to find out more about their lung health and any problems they experience in accessing care
  • These findings have been used to support bids for additional primary care resources for this group of patients
  • Publicising and monitoring the uptake of flu vaccinations (working with pharmacies)

2. A review of the research literature on the association between poor lung health and opiate misuse.

3. An analysis of routinely collected data from GPs to determine ‘Are opiate users at a higher risk of unstable or poorly controlled asthma compared to the general population?’

The results of studies 2 and 3 are in the process of being published 

Publications

Mitchell CA, Pitt A, Hulin J, et alRespiratory health screening for opiate misusers in a specialist community clinic: a mixed-methods pilot study, with integrated staff and service user feedback BMJ Open 2016;6:e012823. doi: 10.1136/bmjopen-2016-012823 http://dx.doi.org/10.1136/bmjopen-2016-012823