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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.
Among patients dependent on prescription opioids, ongoing maintenance therapy using a legal opiate substitute (buprenorphine–naloxone) produced better outcomes than tapered withdrawal, with patients less likely to have used illicit opioids and considerably more likely to have remained in their allocated treatment.
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell B3: Practitioners; Medical treatment
Seminal and key research and reviews on the influence of the practitioner in the medical treatment of drug dependence. Investigates the how clinician-patient relationships might be affected by enforcing clinic rules and the potential importance of doctors forming a “whole person’ relationship with patients.
DOCUMENT 2017 HTM file
Drug misuse and dependence: UK guidelines on clinical management
Last published in 2007, there is no more important document for UK clinicians involved in treating problem drug use than the so-called ‘Orange guidelines’. This major update offers detailed guidance on the range of problems, settings and patients clinicians encounter, substantially informing judgements of what constitutes good medical practice.
HOT TOPIC 2016 HTM file
Prizes for not using drugs?
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Contingency management programmes reward patients for complying with treatment or not engaging in undesired substance use. It works, but often only temporarily – and perhaps at the cost of eroding the patient’s confidence and motivation.
From the USA’s professional society for clinicians and allied professionals in the field of addiction medicine, comprehensive recommendations on how doctors can use medications to treat addiction to heroin and other opioids.
Practitioner-friendly review from the British Association for Psychopharmacology on drug-based treatments for substance dependence offer authoritative, evidence-based guidance to prescribers and others; they also demonstrate the limitations of trying to cure over-use of drugs with drugs.
DOCUMENT 2013 HTM file
Can we dispense with counselling, therapy, treatment as we know it, and just punish or deprive patients of rewards when they use substances in undesired ways, and reward them when they behave as we/they would wish? British services are trialling an approach about which many clinicians express major ethical concerns – contingency management.
Further evidence from Iran that rapid withdrawal from opioids under anaesthesia followed by the opioid-blocking drug naltrexone can work for highly motivated caseloads with copious 'recovery capital'. For others this expensive and when not adequately controlled, potentially risky procedure generally ends in overdose-threatening relapse.
Unequivocal backing from UN agencies for methadone and other forms of long term maintenance treatments as the prime modality for the treatment of dependence on heroin and allied drugs. In contrast say the experts, detoxification results in poor long term outcomes.
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