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Buprenorphine may be associated with a lower risk of mortality than methadone among people engaged in opioid substitution treatment – but is the pattern of short treatment duration in the UK preventing maximal impact at a population level?
Based on detailed treatment records kept by the Canadian province of British Columbia, a slow taper liberally interspersed with stabilisation periods offers the best chance of sustainably withdrawing from methadone without severe relapse, but still very few manage to avoid this risk – an argument for careful consideration and informed consent before making the attempt.
How do different pathways for the treatment of problem opioid use compare under real-world conditions? For US patients with health insurance, opioid substitution therapy was associated with the greatest risk reduction. However, its protective effect may not be fully realised while federal and insurance plan restrictions continue to limit access to this treatment option.
This unique randomised trial tested what would happen if detoxified opiate addicts were then maintained on a substitute drug, on an opiate-blocking medication, or simply counselled. The results led to the introduction of methadone prescribing programmes in Malaysia.
Practice-oriented review of what we know about the diversion (to other people) and misuse (mainly by injecting it) of buprenorphine used in the treatment of opiate dependence, featuring extended, practical guidance on how to identify and respond to these life-threatening behaviours as a therapeutic challenge rather than a disciplinary issue.
STUDY 2000 PDF file 144Kb
Methadone's failures respond to heroin
A large-scale trial in Switzerland suggests that despite failures with other treatments, many long-term heroin addicts respond well to a treatment based on injectable heroin.
REVIEW 2011 HTM file
Heroin maintenance for chronic heroin-dependent individuals
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.
The UK has a long history of prescribing heroin for the treatment of heroin dependence. What has research from six countries concluded about this intensive intervention intended for patients who would otherwise be considered ‘unresponsive’ to treatment?
Slow-release capsules of morphine – the closest drug to heroin – might offer acceptable and effective treatment to addicts who cannot settle on methadone. In England a dozen also being prescribed heroin switched their supplementary methadone to morphine, generally experiencing the benefits they expected and cutting their average dose of heroin.
STUDY 2003 PDF file 164Kb
Naltrexone implants could reduce the early relapse rate after detoxification
Studies from the UK and Germany suggest that subcutaneous implants of naltrexone which block the effects of heroin for up to seven weeks could help reduce the early relapse rate after detoxification more effectively than the oral form of the medication.
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