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Having for several hours to medically monitor opiate-addicted patients starting buprenorphine maintenance is a major impediment to spreading the benefits of the treatment, but this first randomised trial suggests that many patients can manage the process safely at home.
Prescribing oral methadone to heroin addicts divides opinions, but prescribing injectable heroin elevates the controversy to another level. Fortunately we now have six randomised clinical trials involving over 1500 patients to ground us in the evidence – and this European Union review to pull it all together.
Is regular counselling really essential to the effectiveness of methadone maintenance treatment, or are treatment entry and the power of high-dose methadone enough in themselves for many patients? At least in the first four months, this US study suggests the latter.
The first systematic review of whether integrated substance use/parenting programmes improve the parenting of problem substance using mothers found remarkably few quality studies, but enough to suggest that such programmes can improve the prospects of often highly at-risk children.
REVIEW 2012 HTM file
Effect of buprenorphine dose on treatment outcome
How much buprenorphine does it take to keep patients in treatment and suppress illicit use of heroin or other opiate-type drugs? This review concludes that on average higher is better than lower, but that individualising dose and a preparedness to go high if needed are the keys to effective treatment.
DOCUMENT 2013 HTM file
Community loses from failure to offer maintenance prescribing in prisons
An international team of experts has argued that failure to implement effective opioid maintenance programmes in prison represents an important missed opportunity to engage high-risk drug users in treatment, at possibly substantial costs to the individuals and to the community. Is Britain too losing out, and how does the future look?
This US randomised trial in Rhode Island among formerly opiate dependent prisoners found that starting methadone treatment in prison radically improved treatment uptake on release and reduced heroin and cocaine use over the following six months, confirming results from Baltimore.
From Canada the first study to show that among long-term, severely opiate dependent patients who have not responded well to prior treatment, women as well as men benefit more from being prescribed injectable heroin than oral methadone.
In Sydney in Australia an official campaign and educational efforts had the desired effect of shifting staff attitudes in methadone maintenance clinics away from achieving abstinence and withdrawal and towards long-term treatment aimed at reducing harm.
Seminal study of how to train out socially derived attitudes to methadone maintenance as a policy solution to a social problem and train in attitudes which place it within mainstream medical practice as a treatment of individuals which does not 'fix' their problems but offers the opportunity for positive change.
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