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This wide-ranging review uniquely draws together findings from authoritative reviews of rigorous research conducted for the Cochrane collaboration and later studies concerned with the pharmacological and psychosocial treatment of dependence on opiate-type drugs like heroin, concluding that retention is the common key to success.
In the US homeland of competition and private health care, it was cooperation and coordination which led to the introduction of new medications and innovations to promote continuing care – plus the exercise of regulatory and financial muscle and the salutary experience of senior staff who placed themselves in the patient's shoes.
Though tailored for Canada, these guidelines from an internationally respected centre offer valuable guidance to clinicians in Britain and elsewhere on a form of the main alternative to methadone for the maintenance treatment of addiction to heroin and allied drugs, one whose greater safety counterbalances greater cost.
Update of Cochrane review of rigorous studies surprisingly finds that adding psychosocial therapy to opiate substitute prescribing makes no difference to retention or substance use – a testament to the power of the routine treatment and a blow (but not a fatal one) to hopes that extra therapy would aid recovery and treatment exit.
Few treatments for opiate addiction arouse as much controversy as naltrexone implants. Inserted under the skin, these block the effects of heroin for up to several months - for some, a magic bullet, for others, an unsafe and ethically dubious experiment. More evidence from Australia that the overdose death risk is less than with oral forms of the drug.
Concerned that this might on balance cause more deaths by limiting an effective treatment for opiate addiction, an expert panel convened by the US government has changed its mind on whether the risk of a fatal heart attack potentially posed by methadone justifies routine electrocardiogram screening of patients.
Does the small risk of fatal heart attack potentially posed by methadone justify routine electrocardiogram screening of patients, or will this cause more deaths by limiting an effective treatment for opiate addiction? A US clinic tried it and found three at-risk patients in three years.
Update of the first authoritative review to combine results from all trials to date of long-term heroin prescribing for the management of heroin addiction finds important advantages for seemingly intractable patients previously failed by methadone, including reduced illegal drug use.
In the first study of its kind opiate-dependent prisoners in Norway were randomly allocated to a six-month implant which blocks the effects of heroin or to methadone which substitutes for heroin as a way of bridging the period after release. Among the few interested in either option, they led to equivalent reductions in opiate use and crime.
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