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Research
ROSIE: Research Outcome Study In Ireland
Research Study
Background to Study
Heroin use, with its associated harms, represents a serious public health concern and generates many challenges for drug service providers and policy makers. In Ireland, an estimated 14,452 individuals are thought to be heroin dependent, with more people being treated for dependency on opiates then any other drug. Recognition of the harms associated with heroin dependency, and the chronic nature of this condition has lead to increased availability of, and access to treatment and/or rehabilitative services, in the country, under the National Drug Strategy.
Many international outcome studies have provided data supporting the overall effectiveness of established treatment options. In recognition of the need to establish whether these generally positive outcomes of treatment for heroin dependency generalise to the situation in Ireland, the National Advisory Committee on Drugs (NACD) commissioned a national drug treatment outcome study, Research Outcome Study in Ireland (ROSIE). The tender was awarded to Dr. Catherine Comiskey at the National University of Ireland, Maynooth in 2003.
The ROSIE study is a naturalistic study of treatment outcomes of a large cohort of opiate users entering treatment. Study participants were interviewed at treatment intake (or as soon as possible thereafter) and at two subsequent six monthly intervals. In order to determine whether the identified behaviour changes were sustained over time, the ROSIE study received additional funding and we have now completed our three-year follow-up interviews.
Study Aims
The Research Outcome Study in Ireland (ROSIE) is the first large scale, prospective, multi-site, national drug treatment outcome study in the country. The primary objective of the study was to evaluate the effectiveness of different kinds of treatments and interventions currently available to opiate users in Ireland. To this end the aims were;
- To undertake the first national, prospective longitudinal drug treatment outcome study;
- To describe the characteristics of people seeking treatment for their problem drug use;
- To examine treatment outcomes at six months, one year and three years after participants commenced their index treatment and;
- To provide an economic cost-estimate for the problems associated with drug use among the cohort.
Method
Design
The study design was based on the established tradition of programme evaluation and longitudinal outcome research. The study employed a before and after research methodology, whereby individuals are used as their own reflexive control. To this end, study participants were interviewed at treatment intake or as soon as possible thereafter, and then six months, one year and three years post treatment.
Agencies
Individuals were recruited from both in-patient (hospitals, residential programmes and G.P.’s) and outpatient settings (community-based clinics, health board clinics and G.P.’s), and across four modalities; methadone maintenance, structured detoxification programmes, abstinence-based treatment programmes and needle exchanges. These modalities were selected as they were considered to be representative of the main national treatment options available to drug users in Ireland. In total 44 agencies providing approximately 54 services located in rural, urban and inner-city areas in Ireland were involved in the study. The two criteria for agency participation in the study were; location of the services (in as far as possible to include agencies outside Dublin) and capacity to recruit individuals to the study within the restricted time period.
The ROSIE treatment agencies were distributed throughout Ireland and the majority of health boards were represented in the study.
Participants
Client eligibility criteria were to be:
- Over 18 years of age
- Commencing a ‘new treatment episode’
- Prepared to consent to the tracking/follow-up procedures and
- Prepared to provide a range of locator information.
Instrument
A highly structured questionnaire was developed to assess a range of participant characteristics. The main outcome measures were drug using behaviour (including drug type, frequency & quantity of use), treatment history, physical and mental health, and crime. The follow-up research instrument was an abbreviated form of the baseline questionnaire, with questions restricted to behaviour in the preceding 90 days.
A team of trained interviewers from the National University of Ireland, Maynooth administered all questionnaires. Baseline interviews took approximately one hour, subsequent interviews took approximately 30 minutes.
Baseline
Baseline data collection officially commenced in September 2003 and concluded in June 2004. In total 404 participants were interviewed from the following modalities; methadone (53%, n=215), structured detoxification (20%, n=81), abstinence-based treatment (20%, n=82) and needle exchange (7%, n=26). The ROSIE sample consisted of 302 males and 102 females. This 3:1 male to female ratio is broadly representative of the treatment population as a whole.
While the vast majority of study participants were opiate users, poly drug use was the norm. Most participants had a history of injecting drug use. Participants reported a range of mental and physical health complaints and extensive contact with a range of social care services. High crime rates were reported.
Follow-up
Six and twelve month follow-up interviews have been completed. Data has been analysed and for results of the latest 12 month outcomes, please go to our 'Reports and Presentations'. The Baseline report is also available on the website.