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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.
Opioid substitution therapy is a safe and effective approach for suppressing illicit opioid use. Helping to guide optimal provision, this review investigates the relative effects of methadone and buprenorphine on the rate of mortality over time.
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.
Expanding access to medication is an important public health strategy for tackling opioid use disorder, concludes US government agency guidelines. While some people stop using opioids without medication, many benefit from access to methadone, naltrexone, and buprenorphine for varying lengths of time, including lifelong treatment.
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?
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell D3: Organisational functioning; Medical treatment
Seminal and key studies on how treatment organisations affect the implementation and effectiveness of medical interventions and treatment in medical settings. Focus is on UK and US understandings of what counts as a ‘recovery-oriented’ service and on US, Australian and Canadian studies which discovered and validated elements of these visions even before they were articulated.
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.
MATRIX CELL 2017 HTM file
Drug Treatment Matrix cell A2: Interventions; Generic and cross-cutting issues
Seminal and key studies on features common to psychosocial therapy/support and medical treatment. Investigates where treatment is aiming to get to in the form of ‘recovery’, where it starts from as depicted in the brain-disease model of addiction, and the politics of the two most important British drug treatment studies.
Implication of this English study is that to save the lives of people dependent on heroin or similar drugs, they should be engaged and retained in substitute prescribing programmes like methadone maintenance until there is little risk of their relapsing after leaving. Shortly after leaving residential/inpatient settings was the highest risk period.
HOT TOPIC 2015 HTM file
Prescribing opiate-type drugs to opiate addicts: good sense or nonsense?
One of our hot topics offering background and analysis on important issues which sometimes generate heated debate. For decades deeply felt and at times intemperate debate has surrounded a treatment which achieves unparalleled success by going with the grain of addiction, prescribing the same type of drug which opiate-dependent patients used illegally – a substitution castigated as surrender or hailed as an enlightened lifesaver.
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