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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?
From France the first study to randomly allocate patients to start methadone maintenance either in primary care or at a specialist centre found primary care more attractive to patients, and no less effective at reducing street-opioid use and promoting engagement and retention.
From the USA, a rare randomised trial found in favour of continuing methadone maintenance when patients entered prison rather than compulsory withdrawal. The potential benefits were most apparent in the near-100% continuation of protective treatment during the highly overdose-prone weeks after leaving prison.
DOCUMENT 2017 HTM file
Commissioning impact on drug treatment: The extent to which commissioning structures, the financial environment and wider changes to health and social welfare impact on drug misuse treatment and recovery
Based on research, financial data and stakeholder surveys and testimonies, the UK government’s official drug policy advisers warn that without significant efforts to protect investment and quality, in England “loss of funding will result in the dismantling of a drug misuse treatment system that has brought huge improvement to the lives of people with drug and alcohol problems”.
Trials challenge the need for the widely accepted policy of making opioid-dependent patients take their methadone or other opioid substitutes at the clinic or pharmacy, but ‘no difference’ findings may be due to the limitations of the research.
The annual accounting of the treatment caseload in England registers a continuing fall in total numbers and decreasing success with opiate users, while success with drinkers has increased and has for the last few years remained relatively high and stable. An ageing population of opiate users is the proposed explanation for the former trend – but why hasn’t a similarly ageing alcohol caseload also eroded success rates?
Substance use treatment commissioned on a payment-by-results basis in England has been linked to higher rates of in-treatment abstinence and non-injecting than other commissioning models, but lower rates of treatment initiation and completion. Is this enough to support the policy?
Resources spent on supplying ‘cookers’ and filters at needle exchanges may not help curb the spread of hepatitis C. Laboratory simulation suggests infections thought to be have been spread by sharing this equipment may be a proxy for transmission that occurs due to sharing blood-contaminated equipment for dividing drugs.
MATRIX CELL 2017 HTM file
Drug Treatment Matrix cell E1: Local and national systems; Reducing harm
Seminal and key studies relating to local, regional and national systems for effectively and cost-effectively reducing harm.
MATRIX CELL 2017 HTM file
Drug Treatment Matrix cell D1: Organisational functioning; Reducing harm
Seminal and key studies on the influence of the organisation on reducing drug-related harm.
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