{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:46:20Z","timestamp":1777938380967,"version":"3.51.4"},"reference-count":84,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sk\u00e5ne Regional Council"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nordic Studies on Alcohol and Drugs"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>Objectives: Opioid substitution treatment (OST) is often described as a strict and highly regulated treatment method, in which patients have limited influence over their treatment. In 2014, a reform was introduced by the regional council of Sk\u00e5ne in southern Sweden, which allowed OST patients to choose their treatment provider, thus transferring power from care providers to patients. The aim of this study was to examine what this increase in patient influence has meant for the clinics that provide OST in Sk\u00e5ne, and how these clinics have dealt with the new competitive situation that has arisen following the introduction of the reform. Methods: The study is based on two waves of semi-structured interviews with clinic managers at all OST clinics in Sk\u00e5ne. Results: The clinic managers described the increase in patient influence as a positive change, which had led to the patients being treated with more respect. The competition among clinics was expressed, among other things, in the form of differing views on the prescription of benzodiazepines, which initially gave rise to dissatisfaction among clinics with a more restrictive approach to such prescriptions. The reform did not lead to any clear diversity between clinics, apart from different approaches to the prescription of benzodiazepines. The incentive for competition-based diversity is, however, limited by the strict national regulatory system and by the reimbursement system, which restricts the ways in which clinics can conduct treatment activities. Conclusion: OST-clinic managers were largely positive about the increased patient empowerment and the shift in power balance associated with the patient choice reform. The introduction of the reform did not lead to any clear diversity between treatment providers, apart from differing views on the prescription of benzodiazepines, which by some managers was regarded as unfair competition.<\/jats:p>","DOI":"10.1177\/14550725221075003","type":"journal-article","created":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:58:42Z","timestamp":1643763522000},"page":"279-300","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["A transition of power in opioid substitution treatment: Clinic managers' views on the consequences of a patient choice reform"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0828-2482","authenticated-orcid":false,"given":"Lisa","family":"Andersson","sequence":"first","affiliation":[{"name":"Malm\u00f6 University, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,2,1]]},"reference":[{"key":"bibr1-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-137-05053-3"},{"issue":"10","key":"bibr2-14550725221075003","author":"Amato L.","year":"2011","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"bibr3-14550725221075003","doi-asserted-by":"crossref","DOI":"10.24834\/2043\/25469","volume-title":"Valfrihet och egenmakt: en utv\u00e4rdering av Region Sk\u00e5nes v\u00e5rdval f\u00f6r LARO [Freedom of choice: An evaluation of patient choice in substitution treatment in Region Sk\u00e5ne]","author":"Andersson L.","year":"2018"},{"key":"bibr4-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1080\/09687637.2019.1591342"},{"key":"bibr5-14550725221075003","volume-title":"V\u00e5rdval i specialistv\u00e5rden. Utveckling och utmaningar [Patient choice in specialist care: Developments and challenges]","author":"Anell A.","year":"2013"},{"issue":"2","key":"bibr6-14550725221075003","first-page":"403","volume":"60","author":"Bacon M.","year":"2020","journal-title":"The British Journal of Criminology"},{"key":"bibr7-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1177\/0269881116675508"},{"key":"bibr9-14550725221075003","doi-asserted-by":"publisher","DOI":"10.4324\/9781003130079"},{"key":"bibr11-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1080\/13691457.2012.739560"},{"key":"bibr12-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9515.2004.00382.x"},{"key":"bibr13-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1023\/A:1005574918294"},{"key":"bibr14-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2007.03.008"},{"key":"bibr15-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1080\/10550880802122620"},{"key":"bibr16-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"bibr17-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1007\/978-88-470-5480-6_1"},{"key":"bibr18-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2011.03637.x"},{"key":"bibr19-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1111\/add.13087"},{"key":"bibr20-14550725221075003","doi-asserted-by":"publisher","DOI":"10.4324\/9781315382869-9"},{"key":"bibr21-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2011.01.004"},{"key":"bibr22-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2010.03140.x"},{"key":"bibr23-14550725221075003","volume-title":"Marketisation in Nordic eldercare: A research report on legislation, oversight, extent and consequences","author":"Erlandsson S.","year":"2013"},{"key":"bibr24-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2009.03.006"},{"key":"bibr26-14550725221075003","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2013.22"},{"key":"bibr27-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2020.1824046"},{"key":"bibr28-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.04.026"},{"key":"bibr29-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1057\/9780230582569"},{"key":"bibr30-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1177\/0958928712463158"},{"key":"bibr31-14550725221075003","volume-title":"Surviving heroin: Interviews with women in methadone clinics","author":"Friedman J.","year":"2001"},{"key":"bibr32-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2006.01714.x"},{"key":"bibr33-14550725221075003","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2015.144"},{"key":"bibr34-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1177\/1049732311432718"},{"key":"bibr35-14550725221075003","volume-title":"Exit, voice, and loyalty: Responses to decline in firms, organizations, and states","volume":"25","author":"Hirschman A. O.","year":"1970"},{"key":"bibr36-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2007.01.011"},{"key":"bibr37-14550725221075003","volume-title":"Socialstyrelsens f\u00f6reskrifter och allm\u00e4nna r\u00e5d om l\u00e4kemedelsassisterad behandling vid opioidberoende [National board of health and welfare directives and general guidelines on substitution treatment for opioid dependence]","author":"HSLF-FS 2016:1","year":"2016"},{"key":"bibr38-14550725221075003","volume-title":"Perspektiv p\u00e5 sociala problem [Perspectives on social problems]","author":"J\u00e4rvinen M.","year":"2013"},{"key":"bibr39-14550725221075003","volume-title":"On the margins: Nordic alcohol and drug treatment 1885\u20132007","author":"Johnson B.","year":"2007"},{"key":"bibr40-14550725221075003","volume-title":"Alkohol-och narkotikaproblem","author":"Johnson B.","year":"2017"},{"key":"bibr41-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1111\/add.13960"},{"key":"bibr42-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.07.004"},{"key":"bibr43-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2008.10.005"},{"key":"bibr44-14550725221075003","volume-title":"V\u00e5rdvalets och ers\u00e4ttningsmodellens effekter f\u00f6r L\u00e4kemedelsassisterad rehabilitering vid opiatberoende (LARO) [The effects of the patient choice and the compensation model on opioid substitution treatment]. KEFU\u2014R\u00e5det f\u00f6r kommunalekonomisk forskning och utbildning [The council for municipal economical research and education]","author":"KEFU.","year":"2015"},{"key":"bibr45-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1080\/09687630601073807"},{"key":"bibr46-14550725221075003","volume-title":"Om valfrihetssystem (LOV) [The act on system of choice in the public sector]","author":"Lagen"},{"key":"bibr47-14550725221075003","volume-title":"Kritiskt socialt arbete [Critical social work]","author":"Lalander P.","year":"2012"},{"key":"bibr48-14550725221075003","volume-title":"M\u00e4nniskor beh\u00f6ver m\u00e4nniskor : Att lyssna till de misst\u00e4nkliggjorda [People need people: To listen to those who have been made suspicious]","author":"Lalander P.","year":"2016"},{"key":"bibr49-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.encep.2008.05.005"},{"key":"bibr50-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2016.12.005"},{"key":"bibr51-14550725221075003","volume-title":"On the front lines: Managerialism in substance abuse agencies","author":"Lewiskin J.","year":"2018"},{"key":"bibr52-14550725221075003","doi-asserted-by":"publisher","DOI":"10.3109\/16066359909004387"},{"key":"bibr53-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002965"},{"issue":"2","key":"bibr54-14550725221075003","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD002207.pub4","author":"Mattick R. P.","year":"2014","journal-title":"The Cochrane Database of Systematic Reviews"},{"key":"bibr55-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2017.1342662"},{"key":"bibr56-14550725221075003","volume-title":"En dyster parentes : Opiatregeln i svensk LARO-behandling 2010\u20132016 [A dismal parenthesis : The opiate rule in Swedish opioid maintenance treatment 2010\u20132016]","author":"Monwell B.","year":"2019"},{"key":"bibr57-14550725221075003","first-page":"20","volume":"6","author":"Monwell B.","year":"2018","journal-title":"Heroin Addiction and Related Clinical Problems"},{"key":"bibr58-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1080\/13814788.2017.1375091"},{"key":"bibr59-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1177\/145507251002700610"},{"key":"bibr60-14550725221075003","volume-title":"Medicinsk utv\u00e4rdering av V\u00e5rdval LARO i Region Sk\u00e5ne [A medical evaluation of patient choice in substitution treatment in region Sk\u00e5ne]","author":"Nilsson L.-H.","year":"2017"},{"key":"bibr61-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12275"},{"key":"bibr62-14550725221075003","volume-title":"The patient act","author":"Patientlag"},{"key":"bibr63-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2008.07.004"},{"key":"bibr64-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2013.10.001"},{"key":"bibr65-14550725221075003","volume-title":"Kontroll av beroende: Substitutionsbehandlingens logik, praktik och semantik [Controlling addiction: The logic, practice and semantics of methadone maintenance treatment]","author":"Petersson F."},{"key":"bibr66-14550725221075003","volume-title":"Utredning om v\u00e5rdval. L\u00e4kemedelsassisterad Rehabilitering vid Opiatberoende, LARO [Investigation on patient choice: Opioid substitution treatment]","author":"Region Sk\u00e5ne.","year":"2013"},{"key":"bibr67-14550725221075003","volume-title":"Fr\u00e5n stoff till studie : Om analysarbete i kvalitativ forskning [From raw material to a study: On analysis in qualitative research]","author":"Rennstam J.","year":"2015"},{"key":"bibr68-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-015-0037-2"},{"key":"bibr69-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2006.06.017"},{"key":"bibr70-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.1995.10471683"},{"key":"bibr25-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1186\/1747-597X-9-32"},{"key":"bibr71-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-55381-8_1"},{"key":"bibr72-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1177\/145507251002700604"},{"key":"bibr73-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1550"},{"key":"bibr74-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1177\/1455072519886094"},{"key":"bibr75-14550725221075003","volume-title":"The treatment of opioid dependence","author":"Stoller K. B.","year":"2006"},{"issue":"1","key":"bibr76-14550725221075003","volume":"66","author":"Storbj\u00f6rk J.","year":"2020","journal-title":"Sucht \/ Deutsche Hauptstelle Gegen Die Suchtgefahren (dhs), Deutsche Gesellschaft Fur Suchtforschung Und Suchttherapie (dg-Sucht)"},{"key":"bibr77-14550725221075003","unstructured":"Storbj\u00f6rk J., Antonsson E., Stenius K. (2019).\n                      The Swedish addiction treatment system: Government, steering and organisation\n                      . Technical report. Stockholm University: Department of Public Health Sciences. https:\/\/doi.org\/10.17045\/sthlmuni.9906542.v1"},{"key":"bibr78-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1111\/spol.12414"},{"key":"bibr79-14550725221075003","volume":"356","author":"Sun E. C.","year":"2017","journal-title":"BMJ"},{"key":"bibr80-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1159\/000446429"},{"key":"bibr81-14550725221075003","volume-title":"Valfri v\u00e4lf\u00e4rd: ett medborgarperspektiv p\u00e5 den svenska v\u00e4lf\u00e4rdsstaten [Welfare of your choice: A citizens\u2019 perspective on the Swedish welfare state]","author":"Vamstad J.","year":"2015"},{"key":"bibr82-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1111\/dar.13027"},{"key":"bibr83-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2019.01.042"},{"key":"bibr84-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05195-5"},{"key":"bibr85-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1614.2003.01211.x"},{"key":"bibr86-14550725221075003","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2019.03.005"}],"container-title":["Nordic Studies on Alcohol and Drugs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14550725221075003","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/14550725221075003","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14550725221075003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T04:36:53Z","timestamp":1777696613000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/14550725221075003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,1]]},"references-count":84,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1177\/14550725221075003"],"URL":"https:\/\/doi.org\/10.1177\/14550725221075003","relation":{},"ISSN":["1455-0725","1458-6126"],"issn-type":[{"value":"1455-0725","type":"print"},{"value":"1458-6126","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,1]]}}}